A Rare Case of Rheumatoid Arthritis Complicated by Complete Heart Block and Lead Thrombosis

Rhematoid arthritis is a chronic inflammatory autoimmune disease characterized by progressive and disabling symmetrical polyarthritis and other organ damage. Heart manifestations include myocardial , valvular and conduction tissue abnormalities. Complete heart block is rare and results from a direct involvement of the conducting system with granulomas and subsequent fibrosis or extension of the inflammatory process. When symptomatic , it usually presents with lipothimia or syncope. In which case, the treatment of choice is a permanent pacemaker implantation that may complicate with thrombosis. Several hypotheses have been discussed : heart failure, atrial fibrillation, coagulopathie and the pacemaker lead itself may predispose to thrombosis. There are no established standard guidelines for determining the therapeutic course of action following the diagnosis of a clot attached to the cardiac device lead. Some researchers suggest that the decision should depend on the clot's size and the signs and symptoms exhibited by the patients.