A 68-year-old woman presented with active rheumatoid arthritis (RA) and sev
ere extraarticular manifestations. During the course of her treatment, her
electrocardiogram (ECG) transformed from normal sinus rhythm to left bundle
branch block and finally to complete heart block (CHB). Investigations rul
ed out an ischaemic event. A permanent pacemaker was inserted due to the sy
mptoms of heart failure and she made an uneventful recovery. CHB in RA is p
robably a marker of severity of the disease.