Complicated Atrioventricular Block Rheumatoid Arthritis Complete and Intracardiac Mass

Abstract

Rheumatoid Arthritis (RA) is a chronic autoimmune joint disease characterized by persistent systemic inflammation. In rheumatoid arthritis, cardiac involvement is not uncommon and may involve all three tunics of the heart. We report an ex - ceptional case of RA associated with complete Atrioventricular Block (AVB) and intracardiac mobile mass. This is a patient with RA initially put on chloroquine, complicated by a complete BAV implanted with a double chamber pace, then put on corticosteroid therapy and methotrexate for four years. Faced with the worsening of his osteoporosis and the prob - able increase in the threshold of pacemaker stimulation, it was decided to replace methotrexate with leflunomide. As part of the patient's cardiac evaluation, an ETT was performed, inadvertently objectifying a mass in the right atrium attached to the atrial tube and the tricuspid valve without obstruction. Full BAV is very rare. It can be seen especially in old polyarthritis. Several mechanisms can explain this, including rheumatoid nodules; Chloroquine poisoning; amyloid infiltration and rheumatoid vasculitis. The association of RA and intracardiac mass is rare. By analyzing the few cases described in the literature, five main causes are summarized: rheumatoid nodules, cancers, granulomatosis of valves, intracavitary thrombus and infective endocarditis. We discuss through our case, the epidemiological and etiological particularity of the association of RA with a major conductive disorder, as well as the difficulty of the etiological diagnosis of an intracardiac mass in the context of RA.