RECOVERY FROM COMPLETE ATRIOVENTRICULAR-BLOCK CAUSED BY IDIOPATHIC GIANT-CELL MYOCARDITIS AFTER CORTICOSTEROID-THERAPY

Giant cell myocarditis (GCM) is a rapidly progressive disease that lea ds to ventricular tachycardia or high-grade atrioventricular (A-V) blo ck, frequently requiring a pacemaker. A 64-year-old woman developed sy ncope as a result of idiopathic GCM with A-V block. She required both a temporary and a permanent pacemaker. Two-dimensional echocardiograph y showed severely reduced wall motion. There was no histologic or clin ical evidence to suggest sarcoidosis. Despite treatment with diuretics and an angiotensin converting enzyme inhibitor, exertional dyspnea pe rsisted. She received prednisolone 4 months after the onset of complet e A-V block in the late phase of GCM. Prednisolone improved A-V nodal conduction in spite of the fact that there was no influence from LV wa ll motion, and sinus rhythm has continued for more than 2 years. In th is patient, prednisolone was effective in the treatment of GCM.