Successful electrical pacing for complete heart block complicating diphtheritic myocarditis

Abstract

A case of severe diphtheria complicated by myocarditis and neurorespiratory paralysis is reported. The myocarditis manifested with severe conduction disturbances including left bundle branch block and high grade second degree atrioventricular block leading to Adams Stokes attacks. Temporary transvenous electrical pacing for 3 days was successful in the management of this complication, but positive pressure ventilation was later required for respiratory paralysis. This case illustrates the potential value of electrical pacing in diphtheritic myocarditis. Sporadic cases of diphtheria still occur and the case fatality ratio remains at 10 per cent, much of which is related to the occurrence of myocarditis.