Abstract
A 67-year-old woman with rheumatoid arthritis (RA; rheumatic factor and autoantibodies against cyclic citrullinated peptide positive) diagnosed 21 years ago was referred to our hospital because of increasing dyspnea on exertion, fatigue, and dizziness. She had been taking chloroquine (250 mg/d) for 20 years and indomethacin (25 mg/d) for treatment of RA and had no current signs of disease activity. Apart from medically controlled arterial hypertension and chronic renal failure (glomerular filtration rate 39 mL/min) with secondary hyperparathyroidism (intact parathormone 370 ng/L), she had been otherwise healthy. The ECG on admission revealed sinus rhythm with a complete right bundle-branch block. Holter monitoring documented intermittent sinus arrest (up to 3.7 seconds) and frequent symptomatic episodes of junctional escape rhythm of approximately 40/min. Elevated …
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