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Case Reports
. 2025 Oct 1.
doi: 10.1515/jbcpp-2025-0155. Online ahead of print.

Atrioventricular block and myastenia gravis. A case report and review of the literature

Anna Lombardi  1 , Francesco Murru  1 , Luigi Giuseppe Atripaldi  1 , Carmine D'Argenzio  1 , Rita Verdoliva  1 , Giordana G Iannibelli  1 , Claudia Canitano  1 , Mariarosaria De Luca  1 , Giuseppe Cudemo  1 , Rosa Lucci  1 , Andrea Salzano  1   2   3 , Alberto M Marra  1   2 , Michele Arcopinto  1   2 , Antonio Cittadini  1   2
Affiliations
Case Reports

Atrioventricular block and myastenia gravis. A case report and review of the literature

Anna Lombardi et al. J Basic Clin Physiol Pharmacol. .

Abstract

Objectives: Myasthenia gravis (MG) is a chronic autoimmune disease primarily affecting skeletal muscles, though cardiac involvement, particularly arrhythmias, may occur, especially in severe cases or in patients with thymoma.

Case presentation: We report the case of a 62-year-old male with AchR-Ab-positive MG, without thymoma, who developed an advanced atrioventricular block requiring pacemaker implantation. Cardiac manifestations in MG can result from either the disease itself - through myocarditis, autoantibodies and autonomic dysfunction - or as a side effect of treatments such as pyridostigmine and immunosuppressants. Management strategies include considering discontinuation of pyridostigmine or using hyoscyamine to assess potential drug-induced bradyarrhythmias before proceeding with permanent pacing.

Conclusions: This case highlights the diagnostic challenges in distinguishing iatrogenic from autoimmune cardiac complications and emphasizes the importance of cardiovascular monitoring in MG patients, especially those presenting with cardiac symptoms or EKG abnormalities. Early recognition and appropriate intervention are crucial to improve outcomes and quality of life.

Keywords: atrioventricular block; cardiac autoimmunity; myastenia gravis.

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