Guillain-Barr® Syndrome with asystole requiring permanent pacemaker: a case report

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Guillain-Barr─é┬® syndrome is an acute demyelinating disorder of the peripheral nervous system that results from an aberrant immune response directed at peripheral nerves. Autonomic abnormalities in Guillain-Barr─é┬® syndrome are usually transient and reversible. We present a case of Guillain-Barr─é┬® syndrome requiring a permanent pacemaker in view of persistent symptomatic bradyarrhythmia.

Case Presentation
An 18-year-old Caucasian female presented with bilateral lower limb paraesthesias followed by bilateral progressive leg weakness and difficulty in walking. She reported an episode of an upper respiratory tract infection 3 weeks prior to the onset of her neurological symptoms. Diagnosis of Guillain-Barr─é┬® syndrome was considered and a lumbar puncture was performed. Cerebrospinal fluid revealed albuminocytologic dissociation (increased protein but normal white blood cell count) suggestive of Guillain-Barr─é┬® syndrome and hence an intravenous immunoglobulin G infusion was started. Within 48 hours, she progressed to complete flaccid quadriparesis with involvement of respiratory muscles requiring mechanical ventilatory support. Whist in the intensive care unit, she developed multiple episodes of bradycardia and asystole requiring a temporary pacemaker. In view of the persistent requirement for the temporary pacemaker for more than 5 days, she received a permanent pacemaker. She returned for follow-up three months after discharge with an intermittent need for ventricular pacing.

Guillain-Barr─é┬® syndrome can result in permanent damage to the cardiac conduction system. Patients with multiple episodes of bradycardia and asystole in the setting of Guillain-Barr─é┬® syndrome should be evaluated and considered as potential candidates for permanent pacemaker implantation.



Autonomic neuropathy is an important complication of Guillain-Barr─é┬® syndrome (GBS), seen in about 60% cases. It is common in young adults, presents with more severe syndromes, and accounts for the mortality in severely affected individuals. Cardiac autonomic impairment in GBS includes labile hypertension, orthostatic hypotension, and a wide range of cardiac arrhythmias including sinus tachycardia, serious bradyarrhythmias and asystole. These manifestations occur primarily from either an under activity or an excessive activity of the sympathetic or parasympathetic pathways. We report a case of Guillain-Barr─é┬® syndrome requiring permanent pacemaker for severe bradycardia.




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