Help With a 20 Year Old Told to Get a Pacemaker.

The patient is 20 years old. He was found with a first degree atrial-ventricular block when he was 9 years old which was suspected to be caused by myocarditis. After two weeks of injection of penicillin and nourishment medicine there was no improvement. No further action was taken.

During the diagnosis in august 2007, the 24 hour ECG observation showed during the night intermittent second degree and third degree atrial-ventricular blocks. Total beats 68000, nodal bradycardia 13000, the highest nodal beats 112, the lowest nodal beats 22. RR interval > 2 seconds 1390 times, the longest interval 2.6-2.8 seconds. But in the daytime, the heart beat goes up to more than 100 times, and the symptoms totally disappear and nodal heart rate is normal. Ultrasound shows no abnormalities about the size and structure of the heart.

We have two questions:
1. The cause. Some experts think it was caused by myocarditis. Others think it was caused by high tension of the pneumogastric nerve. We wonder what is the real reason and what other tests can help confirm a diagnosis.
2. The treatment. In addition to embedded permanent pacemaker, is there any other medicine can help mitigate or eliminate the symptoms, or other treatments such as pneumogastric nerve RF ablation to control and cure the illness.

Please contact me if anybody have treated or have knowledge of this disease. Thanks a lot.

Hong