title: [Complete auriculoventricular blockage in adult patients with systemic lupus erythematosus. Case series and a review of the literature].
abstract: OBJECTIVE
  Congenital complete atrioventricular heart block (CHB) is due to the lesion of the cardiac conduction system by specific transplacental antibodies of maternal origin. In adults with systemic lupus erythematosus (SLE), cardiac toxicity is very questionable and has been related to treatment with synthetic antimalarial drugs (AM). Here we evaluate, in our geographic area, the presence of non congenital CHB in adult patients with SLE and its possible association with AM treatment.
  
  
  METHODS
  The frequency of CHB has been studied revising the clinical records of 595 SLE patients followed at the Unit for Systemic Diseases.
  
  
  RESULTS
  Five women (0.8% of the total series) suffered from CHB (2 patients developed it during a lupic crisis). All were on treatment with AM (100 versus 60% of the rest of the series) and maintained a dose of 250 mg/day (except one, with a dose of 500 mg/day) for a mean period of 90 months. The accumulated mean dose of AM was 753 g. Three patients developed cardiac insufficiency; 2 nephropathy; 2 myopathy; and one maculopathy. As accompanying processes we detected Sjögren's syndrome (2) and hypothyroidism (3). The frequency of HLA DR3, positive in 80% of the cases, is higher than observed in the total series, 34% (p = 0.053).
  
  
  CONCLUSIONS
  We detected the presence of CHB in 0.8% of SLE patients. They were all treated with AM. We did not verify any relationship with anti-ENA (anti-Ro/La and anti-RNP) antibodies, as communicated by others, but rather a trend to the association with HLA DR3 (at the limit of statistical significance).
authors.affiliation: Servicio de Medicina Interna. Unidad de Colagenosis. Hospital Universitario Virgen del Rocío. Sevilla. España.
authors.forename: Julio
authors.initials: J
authors.lastname: Sánchez Román
authors.forename: Celia
authors.initials: C
authors.lastname: Ocaña Medina
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: García Hernández
authors.forename: Rocío
authors.initials: R
authors.lastname: González León
authors.forename: Rocío
authors.initials: R
authors.lastname: Garrido Rasco
authors.forename: Regina
authors.initials: R
authors.lastname: Colorado Bonilla
authors.forename: Francisca
authors.initials: F
authors.lastname: González Escribano
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Wichmann