Complete heart block in rheumatoid arthritis

SUMMARY We report 8 cases of complete heart block (CHB) occurring in patients with rheumatoid arthritis and review 20 similar patients previously reported. Complete heart block occurs generally in patients with established erosive nodular rheumatoid disease. It usually appears to be sudden and permanent, but progression from minor conduction delays is not uncommon. The characteristic histopathological finding is a rheumatoid granuloma in or near the AV node or bundle of His. If syncope or Stokes-Adams attacks occur, the treatment of choice is the insertion of a permanent pacemaker. The prognosis is good provided no other cardiac lesions occur, whether pericardial, valvular, or myocardial. The first account of cardiac involvement in rheumatoid arthritis was given by Charcot in 1881,' when he described pericarditis both as a clinical and as a necropsy finding in patients with 'rheumatisme articulaire chronique'. No further observations were made for sixty years when Baggenstoss and Rosen-berg in 19412 noted valvular lesions in associatio