Reversible Atrioventricular Block and Junctional Ectopic Tachycardia in Coxsackievirus B3-Induced Fetal–Neonatal Myocarditis without Left Ventricular Dysfunction

Abstract

We present a case of fetal–neonatal acute myocarditis caused by coxsackievirus B3 infection in a term neonate. The condition manifested as high-grade atrioventricular (A-V) block prenatally. After delivery, various arrhythmias such as high-grade A-V block, ventricular tachycardia, and junctional ectopic tachycardia appeared, and we had difficulty managing these arrhythmias. This is the first report describing a case of acute myocarditis due to coxsackievirus infection presenting with fetal A-V block. This case is also unique in that it is extremely rare that various arrhythmias occur serially in one patient without left ventricular dysfunction.

Keywords

Myocarditis - junctional ectopic tachycardia - fetal atrioventricular block - amiodarone hydrochloride

• References

• 1 Bryant PA, Tingay D, Dargaville PA, Starr M, Curtis N. Neonatal coxsackie B virus infection—a treatable disease?. Eur J Pediatr 2004; 163: 223-228
• 2 Ouellet A, Sherlock R, Toye B, Fung KF. Antenatal diagnosis of intrauterine infection with coxsackievirus B3 associated with live birth. Infect Dis Obstet Gynecol 2004; 12: 23-26
• 3 Repke JT, Kuhajda F, Hochberg MC, Johnson TR, Winn K, Provost T. Fetal viral myocarditis and congenital complete heart block in a pregnancy complicated by systemic lupus erythematosus. A case report. J Reprod Med 1987; 32: 217-220
• 4 Batra AS, Chun DS, Johnson TR , et al. A prospective analysis of the incidence and risk factors associated with junctional ectopic tachycardia following surgery for congenital heart disease. Pediatr Cardiol 2006; 27: 51-55
• 5 Lupoglazoff JM, Denjoy I, Luton D, Magnier S, Azancot A. Prenatal diagnosis of a familial form of junctional ectopic tachycardia. Prenat Diagn 1999; 19: 767-770
• 6 Goren A, Kaplan M, Glaser J, Isacsohn M. Chronic neonatal coxsackie myocarditis. Arch Dis Child 1989; 64: 404-406
• 7 Shah SS, Hellenbrand WE, Gallagher PG. Atrial flutter complicating neonatal Coxsackie B2 myocarditis. Pediatr Cardiol 1998; 19: 185-186
• 8 Hoi-shan Chan S, Lun KS. Ventricular aneurysm complicating neonatal coxsackie B4 myocarditis. Pediatr Cardiol 2001; 22: 247-249
• 9 Bauer S, Gottesman G, Sirota L, Litmanovitz I, Ashkenazi S, Levi I. Severe Coxsackie virus B infection in preterm newborns treated with pleconaril. Eur J Pediatr 2002; 161: 491-493
• 10 Bendig JW, Franklin OM, Hebden AK , et al. Coxsackievirus B3 sequences in the blood of a neonate with congenital myocarditis, plus serological evidence of maternal infection. J Med Virol 2003; 70: 606-609
• 11 Lu JC, Koay KW, Ramers CB, Milazzo AS. Neonate with coxsackie B1 infection, cardiomyopathy and arrhythmias. J Natl Med Assoc 2005; 97: 1028-1030
• 12 Krogstad P, Hammon R, Halnon N, Whitton JL. Fatal neonatal myocarditis caused by a recombinant human enterovirus-B variant. Pediatr Infect Dis J 2008; 27: 668-669
• 13 Nathan M, Walsh R, Hardin JT , et al. Enteroviral sepsis and ischemic cardiomyopathy in a neonate: case report and review of literature. ASAIO J 2008; 54: 554-555
• 14 Simpson KE, Hulse E, Carlson K. Atrial tachyarrhythmias in neonatal enterovirus myocarditis. Pediatr Cardiol 2009; 30: 827-830
• 15 Freund MW, Kleinveld G, Krediet TG, van Loon AM, Verboon-Maciolek MA. Prognosis for neonates with enterovirus myocarditis. Arch Dis Child Fetal Neonatal Ed 2010; 95: F206-F212
• 16 Maiers JA, Ebenroth ES. Junctional ectopic tachycardia following complete heart block associated with viral myocarditis. Pediatr Cardiol 2006; 27: 367-368
• 17 Inwald D, Franklin O, Cubitt D, Peters M, Goldman A, Burch M. Enterovirus myocarditis as a cause of neonatal collapse. Arch Dis Child Fetal Neonatal Ed 2004; 89: F461-F462