Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy: A case report

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.

Keywords: Secondary hyperparathyroidism; Ectopic calcification; Atrioventricular block; Reversal; Case report

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.