Anti-Ro antibodies and complete heart block in adults with Sjögren’s syndrome

Abstract

There are emerging case reports worldwide of complete heart block in adults who test positive foranti-Ro antibodies and the underlying primary Sjögren’s syndrome (pSS). The association betweenfetal/congenital cardiac abnormalities and transplacental transfer of anti-Ro antibodies is well estab-lished; there is, however, an ongoing debate about the underlying mechanism of activity of these an-tibodies in the cardiac tissue. In the past, maternal cardiac tissue was believed to be resistant to thesepathogenic effects. This case highlights the need to change our understanding of how these anti-bodies cause adverse arrhythmogenic cardiac effects in adults. We present the case of a 44-year-oldfemale with pSS and positive anti-Ro autoantibodies, who was diagnosed with autoimmune-inducedcomplete heart block after presenting with dizziness and palpitations. She required insertion of a per-manent cardiac pacemaker and has made a full recovery. Although the arrhythmogenic effects arerare, it may be that cardiac conduction in adults is not as resistant to anti-Ro antibodies as proposed.