The Important Role of Temporary Pacemaker in the Complete Atrioventricular Block Due to Diphtheria

Abstract

Diphtheria has still existed and highland Vietnam, where 49 cases suffered occur in 2020 in Gialai province with 2 cases of deaths. Infection with toxigenic Corynebacterium diphtheriae may result in widespread toxin-mediated damage, particularly in the kidneys, nervous system, and heart (i.e., diphtheritic myocarditis). Diphtheritic myocarditis occurs in 10–20% of patients who initially present with oropharyngitis. Overall, diphtheritic myocarditis has an associated mortality rate of∼60%, and it accounts for the majority of deaths related to diphtheria. However, patients with myocarditis who survive appear to make a full recovery. A case of severe diphtheria complicated by myocarditis is reported in Gialai province. The myocarditis manifested with severe conduction disturbances including left bundle-branch block and atrioventricular block third degree. Antitoxin has proven its value in the early stages of the illness, but it has limited action against penetrating toxins or toxins already absorbed into the cell. Temporary transvenous electrical pacing for 5 weeks was successful in the management of this complication. This case illustrates the potential value of electrical pacing in diphtheritic myocarditis.