case_images: PMC11098578_01
case_images: - Monitoramento Holter demonstrando dois episodios de bloqueio atrioventricular (AV) paroxistico apos o termino do tratamento com antibioticos. O monitoramento continuo do Holter revelou que os disturbios da conducao AV (incluindo bloqueio AV paroxistico de alto grau) persistiram apos quatro semanas de tratamento antibiotico apropriado. O painel A mostra um bloqueio AV 2:1 de segundo grau. O painel B mostra um bloqueio AV de alto grau com assistolia ventricular de 2,96 segundos.
case_images: 0066-782X-abc-121-1-e20230228-gf01.jpg
case_images: PMC11098578_01_0066-782X-abc-121-1-e20230228-gf01.jpg
case_images: f01
case_images: T-wave inversion in inferior and V3-V6 leads (Supplementary Figure 1 ). The chest radiograph was normal. Nevertheless, in our patient, the AV conduction disturbance (including high-grade AV block) persisted after four weeks of appropriate antibiotic treatment, as demonstrated by Holter monitoring ( Figure 1 ). Holter monitoring before theophylline showed around 78 blocked P waves, including second-degree Mobitz I AV block, second-degree 2:1 AV block, and high-grade AV block (3:1 and 4:1), with two significant ventricular asystoles, the largest of which was 2960 milliseconds due to high-grade AV block (4:1) [ Figure 1 ]. Holter monitoring following theophylline administration revealed a noteworthy reduction of approximately 38% of blocked P waves (from 78 to 48), mostly due to second-degree Mobitz I AV block, with only two episodes of 3:1 AV block and no ventricular asystole longer than 2000 milliseconds.
case_images: - Holter monitoring demonstrating two episodes of paroxysmal atrioventricular (AV) block after completion of antibiotic treatment. Continuous Holter monitoring revealed that AV conduction disturbances (including paroxysmal high-grade AV block) persisted after four weeks of appropriate antibiotic treatment. Panel A shows a second-degree 2:1 AV block. Panel B shows a high-grade AV block with a ventricular asystole of 2.96 seconds.
case_images: 0066-782X-abc-121-1-e20230228-gf01-en.jpg
case_images: PMC11098578_01_0066-782X-abc-121-1-e20230228-gf01-en.jpg
case_images: f01001
case_images: During hospitalization, continuous cardiac monitoring revealed several asymptomatic episodes of paroxysmal AV block (Supplementary Figure 2), including second-degree Mobitz I AV block, second-degree 2:1 AV block, and high-grade AV block (3:1 and 4:1).