PMC6854947_01
PMC6854947_02
Electrocardiograms (a). Sinus arrest was detected (b-1), junctional rhythms ( ) were pointed with retrograde P waves ( ), and short bursts of atrial tachycardia were detected ( ). Atrial flutter occured with a resultant 2 : 1 to 4 : 1 atrioventricular conduction block (c). Sinus arrest occured (maximum, 5.7 s) (d).
CRIPE2019-7358753.001.jpg
PMC6854947_05_CRIPE2019-7358753.001.jpg
fig1
An atrial flutter was detected on day 20 of the illness (Figure 1(c)). The patient was subsequently administered flecainide to prevent atrial flutter; however, this treatment was discontinued due to a significant sinus arrest of 5.7 seconds (Figure 1(d)).
PMC6854947_03
Clinical course.
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fig2
However, the fever recurred on day 10 of the illness, and the patient's level of consciousness deteriorated; therefore, additional 2 g/kg of IVIG and edaravone (1 mg/kg/day) were administered (Figure 2).
PMC6854947_04
Electrocardiograms (a). Sinus arrest was detected (b-1), junctional rhythms ( ) were pointed with retrograde P waves ( ), and short bursts of atrial tachycardia were detected ( ). Atrial flutter occured with a resultant 2 : 1 to 4 : 1 atrioventricular conduction block (c). Sinus arrest occured (maximum, 5.7 s) (d).
CRIPE2019-7358753.001.jpg
PMC6854947_05_CRIPE2019-7358753.001.jpg
fig1
An atrial flutter was detected on day 20 of the illness (Figure 1(c)). The patient was subsequently administered flecainide to prevent atrial flutter; however, this treatment was discontinued due to a significant sinus arrest of 5.7 seconds (Figure 1(d)).
PMC6854947_05
Electrocardiograms (a). Sinus arrest was detected (b-1), junctional rhythms ( ) were pointed with retrograde P waves ( ), and short bursts of atrial tachycardia were detected ( ). Atrial flutter occured with a resultant 2 : 1 to 4 : 1 atrioventricular conduction block (c). Sinus arrest occured (maximum, 5.7 s) (d).
CRIPE2019-7358753.001.jpg
PMC6854947_05_CRIPE2019-7358753.001.jpg
fig1
An atrial flutter was detected on day 20 of the illness (Figure 1(c)). The patient was subsequently administered flecainide to prevent atrial flutter; however, this treatment was discontinued due to a significant sinus arrest of 5.7 seconds (Figure 1(d)).
Coronary angiography (on day 25 of the illness). The arrow indicates sinus node branch from the right coronary artery. There was no dilatation or stenosis of the coronary arteries.
CRIPE2019-7358753.003.jpg
PMC6854947_05_CRIPE2019-7358753.003.jpg
fig3
Coronary angiography performed on day 25 of the illness demonstrated no dilatation or stenosis of the coronary arteries, and the sinus node artery was seen in normal origin from the right coronary artery (Figure 3).
Histopathology of myocardium (on day 25 of the illness). There was no finding of the infiltration of the inflammatory cells. The myocardial cell had variation in the size and irregular adhesion, and fibrosis was seen between the muscular fiber. These were not findings of the acute phase but chronic stage, which were delivered by the pressure overload of the right ventricle due to the pulmonary arterial stenosis. Hematoxylin eosin, x160.
CRIPE2019-7358753.004.jpg
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fig4
Myocardial cells exhibited variation in size and irregular adhesion, and fibrosis was detected between the muscular fibers (Figure 4).
PMC6854947_06