Corticotrophin and corticosteroids in the management of acute and chronic heart block.

Clinical studies and individual case reports indicate that corticotrophin and corticosteroids frequently help to restore sinus rhythm in acute complete A-V heart block associated with recent myocardial infarction (Prinzmetal and Kennamer, 1954; Phelps and Lindsay, 1957; Aber and Wyn Jones, 1960; Caramelli and Tellini, 1960; Friedberg et al., 1960; Dall and Buchanan, 1962; Dalil, 1964). However, the true value of this form of treatment in chronic A-V block is less certain. Tung, Lu, and Fu (1957) and Litchfield, Manley, and Polak (1958) each reported two patients with long-standing block who reverted to sinus rhythm under corticotrophin therapy, and Pay and Waverley (1961) restored sinus rhythm in 5 out of 6 patients with chronic heart block, using oral corticosteroids. On the other hand, Caramelli and Tellini (1960) failed to improve A-V conduction in 10 patients, and in Dall's series (Dall, 1964) only 2 of the 14 patients with long-standing block regained sinus rhythm while receiving "steroid" therapy. Our experience of corticotrophin and corticosteroids in the treatment of heart block has been less pessimistic. Restoration of sinus rhythm or improved A-V conduction has not only been achieved in most patients with acute heart block, but also in an appreciable number with heart block of considerable duration.