Xu SS, Hao LH, Guan YM. Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy: A case report. World J Clin Cases 2024; 12(7): 1313-1319 [PMID: 38524519 DOI: 10.12998/wjcc.v12.i7.1313]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 6, 2024; 12(7): 1313-1319 Published online Mar 6, 2024. doi: 10.12998/wjcc.v12.i7.1313
Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy: A case report
Shan-Shan Xu, Li-Hai Hao, Yan-Meng Guan
Shan-Shan Xu, Li-Hai Hao, Yan-Meng Guan, Hemodialysis Center, Weifang People’s Hospital, Weifang 261041, Shandong Province, China
Author contributions: Xu SS and Guan YM wrote the manuscript; Hao LH collected the data and drafted the manuscript; all the authors have read and approved the final manuscript.
Supported byWeifang Health and Family Planning Commission Research Project, No. WFWSJK-2021-212.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: October 19, 2023 Peer-review started: October 19, 2023 First decision: January 5, 2024 Revised: January 18, 2024 Accepted: February 4, 2024 Article in press: February 4, 2024 Published online: March 6, 2024
Abstract
BACKGROUND
Refractory secondary hyperparathyroidism (SHPT) is a common complication observed in patients with end-stage renal disease and can result in ectopic calcification. Metastatic calcification involving the heart valves and the conduction system can easily lead to arrhythmias, including atrioventricular block. This case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block (CAVB), which was eventually reversed to a first-degree atrioventricular block.
CASE SUMMARY
We present the case of a 31-year-old Asian female who was receiving maintenance hemodialysis because of lupus nephropathy. She developed SHPT, and an electrocardiogram revealed a first-degree atrioventricular block. Then, she underwent parathyroidectomy (PTX) with autotransplantation. Unfortunately, a few years later, she developed SHPT again, and an electrocardiogram revealed a CAVB. A few years after the second PTX surgery, the calcification of the left atrium and left ventricle improved, and her CAVB was reversed.
CONCLUSION
This case revealed that metastatic cardiac calcification can result in complete atrioventricular blockage. Following parathyroid surgery, calcification of the cardiac conduction system improved, leading to reversal of the atrioventricular block. It is important for dialysis patients to optimize intact parathyroid hormone therapy and pay attention to calcification metastasis.
Core Tip: Refractory secondary hyperparathyroidism (SHPT) is known to cause bone pain, itching, and muscle weakness and can lead to an increased incidence of pathological fractures, metastatic calcification, and cardiovascular events. Metastatic calcification involving the heart valves and the conduction system, such as the mitral valve ring, can easily lead to arrhythmias, including atrioventricular block. The current case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block, which was reversed to a first-degree atrioventricular block after parathyroidectomy. The importance of optimizing parathyroid hormone management is further highlighted by comparing the pre- and postreversal indices.
