{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T12:04:23Z","timestamp":1768392263703,"version":"3.49.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":289,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Granulomatosis with polyangiitis (GPA), formerly known as Wegener\u2019s granulomatosis, is a rare antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis primarily affecting the respiratory tract and kidneys. Cardiac involvement in GPA, though uncommon, can lead to life-threatening arrhythmias like complete heart block (CHB). A 33-year-old male with a 12-year history of GPA presented with syncope, palpitations, and reduced consciousness. He had discontinued his medications 3\u00a0months earlier. Clinical findings included sensorineural hearing loss, saddle-nose deformity, chronic dacryocystitis, and sinonasal destruction, with no neurological findings. Electrocardiography revealed CHB, prompting temporary pacemaker placement. Echocardiography and coronary angiography excluded structural or ischaemic heart disease. Laboratory parameters and imaging findings supported the diagnosis of GPA relapse. After excluding infectious, metabolic, and drug-related causes of CHB, intravenous methylprednisolone and rituximab were administered. Within 48\u00a0hours of initiating glucocorticoids, CHB improved to a first-degree atrioventricular (AV) block, permitting pacemaker removal. After stabilization, cardiac MRI demonstrated mild biventricular dilation with preserved systolic function, absence of myocardial inflammation or fibrosis, and a minimal pericardial effusion. He was discharged on high-dose prednisolone and scheduled for rituximab, achieving complete symptom resolution and stable cardiac conduction at 1-month follow-up. This case and literature review highlight that early appropriate immunosuppression therapy can successfully reverse CHB without requiring permanent pacing. Patients with unexplained arrhythmias and signs of systemic inflammation should be evaluated early for GPA to guide timely treatment.<\/jats:p>","DOI":"10.1093\/mrcr\/rxaf060","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T12:11:46Z","timestamp":1760616706000},"source":"Crossref","is-referenced-by-count":0,"title":["Successful reversal of complete heart block in granulomatosis with polyangiitis without permanent pacing: a case report with literature review"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6355-9851","authenticated-orcid":false,"given":"Alireza","family":"Mirzamohamadi","sequence":"first","affiliation":[{"name":"Rheumatology Research Center, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9633-4678","authenticated-orcid":false,"given":"Amin","family":"Azizan","sequence":"additional","affiliation":[{"name":"Rheumatology Research Center, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6210-2112","authenticated-orcid":false,"given":"Mehrdad","family":"Mahalleh","sequence":"additional","affiliation":[{"name":"Rheumatology Research Center, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8470-7959","authenticated-orcid":false,"given":"Soraya","family":"Shahrzad","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Medicine, Shariati Hospital, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6413-234X","authenticated-orcid":false,"given":"Najme-sadat","family":"Moosavi","sequence":"additional","affiliation":[{"name":"Tehran Heart Center, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3506-822X","authenticated-orcid":false,"given":"Shokufe","family":"Sadeghi","sequence":"additional","affiliation":[{"name":"Rheumatology Research Center, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4595-3828","authenticated-orcid":false,"given":"Somayeh","family":"Motamed","sequence":"additional","affiliation":[{"name":"Rheumatology Research Center, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9852-2158","authenticated-orcid":false,"given":"Vahid","family":"Ardestani Rostami","sequence":"additional","affiliation":[{"name":"Rheumatology Research Center, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3954-9926","authenticated-orcid":false,"given":"Majid","family":"Alikhani","sequence":"additional","affiliation":[{"name":"Rheumatology Research Center, Tehran University of Medical Sciences , Tehran ,","place":["Iran"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"2026011402215572300_ref1","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1111\/1754-9485.13471","article-title":"Granulomatosis with polyangiitis: common and uncommon presentations","volume":"66","author":"Tee","year":"2022","journal-title":"J Med Imaging Radiat Oncol"},{"key":"2026011402215572300_ref2","first-page":"e71","article-title":"A patient with Wegener\u2019s granulomatosis in apparent remission presenting with complete atrioventricular block","volume":"3","author":"Cassidy","year":"2011","journal-title":"J Cardiol Cases"},{"key":"2026011402215572300_ref3","doi-asserted-by":"crossref","first-page":"386","DOI":"10.5935\/0103-507X.20170052","article-title":"Heart conduction system defects and sustained ventricular tachycardia complications in a patient with granulomatosis with polyangiitis. 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