Syncope due to acute rheumatic fever with pacemaker-like syndrome

Abstract

The prolongation in the PR interval on the electrocardiogram is one ofthe minor criteria of Jones. Abnormal increases in the PR interval lead tohemodynamic impairments caused by atrioventricular asynchrony and is calledpseudo-pacemaker or pacemaker-like syndrome in the literature. A 13-yearold boy who had polyarthralgia for six weeks was referred to the emergencyroom because of syncope while exerting effort. In the electrocardiography,the P wave was regularly seen at the onset of the T wave immediately afterthe QRS wave with extremely prolonged PR interval and mild tachycardia.Also, 24 hours rhythm Holter recording showed atrioventricular dissociation.The echocardiography revealed findings of severe carditis. Diagnosis of acuterheumatic fever accompanying pacemaker-like syndrome was made. Althoughthe recommendation for marked first-degree atrioventricular block thatcauses hemodynamic impairment is pacemaker implantation, a significantimprovement in the PR prolongation was observed in the short term withanti-inflammatory treatment because the impairment of conduction in thepatient was due to inflammation. The pacemaker-like syndrome in a child isbeing reported for the first time in the literature.