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Europace Advance Access originally published online on February 4, 2009
Europace 2009 11(4):527-529; doi:10.1093/europace/eup010
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

SHORT COMMUNICATIONS

Increased stimulation threshold in a patient with autoimmune disease: successful management with oral prednisolone and azathioprine

A. Ferraro*, A. Sibona Masi, A. Mazza, M.C. Rosa Brusin and M.R. Conte

Ospedale degli Infermi Strada Rivalta 29, 10098 Rivoli (TO), Italy

We report a patient with a systemic vasculitis and heart involvement with complete atrio-ventricular block. After pacemaker implantation, the stimulation threshold significantly increased resulting in exit block. Two adjunctive ventricular leads were implanted with temporary threshold improvement. Oral glucocorticoids decreased the stimulation threshold with a transient, dose-dependent efficacy but with remarkable side effects. Azathioprine, an immunosuppressive agent, obtained a sustained decrease of the stimulation threshold.

Key Words: Permanent pacemaker, Exit block, AV block in autoimmune disease, Glucocorticoids, Azathioprine

* Corresponding author. Tel: +39 011 9551426, Fax: +39 011 9551431, Email: annaferraro{at}tiscali.it

Manuscript submitted 3 October 2008. Accepted after revision 12 January 2009.


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