Treating Lyme carditis high‐degree AV block using a temporary–permanent pacemaker

Lyme carditis (LC) is a manifestation of the early disseminated stage of Lyme disease and often presents as high-degree atrioventricular (AV) block. High-degree AV block in LC can be treated with antibiotics, usually resolving with a highly favorable prognosis, thus preventing the unnecessary implantation of permanent pacemakers. We present a systematic approach to the diagnosis and management of LC that implements the Suspicious Index in Lyme Carditis (SILC) risk stratification score.

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A Rare Association of Takotsubo Cardiomyopathy with High-Degree Atrioventricular Block

Case Reports in Cardiology ◽

10.1155/2017/6989438 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Eder Hans Cativo ◽

Rachna Valvani ◽

Tuoyo O. Mene-Afejuku ◽

Diana P. Cativo ◽

Savi Mushiyev

Keyword(s):

Atrioventricular Block ◽

Takotsubo Cardiomyopathy ◽

Permanent Pacemaker ◽

Av Block ◽

Early Presentation ◽

Reduced Ejection Fraction ◽

Nonobstructive Coronary Artery Disease ◽

Artery Disease ◽

Tissue Abnormalities ◽

High Degree

Here we present a case of a patient who got trapped in an elevator; on initial evaluation patient was found with bradycardia; on further evaluation electrocardiogram (EKG) showed new onset 2nd-degree Mobitz type 2 AV block. On admission patient developed ischemic changes on EKG and troponin elevation. Transthoracic echocardiogram showed reduced ejection fraction as well as apical inferior, anterior, lateral, and septal hypokinesia. Coronary angiography showed nonobstructive coronary artery disease and ventriculogram demonstrated anterolateral and apical hypokinesia suggesting takotsubo cardiomyopathy (TCM). Atrioventricular block (AV) is rarely seen as initial presentation of TCM and has a prevalence of about 2.9%. AV block during early presentation of TCM poses a therapeutic dilemma with regard to the timing and the need to place a temporary or permanent pacemaker. The decision to place a permanent pacemaker may be on a case-by-case basis and more research is needed on formulating standardized recommendations in patients with TCM and conduction tissue abnormalities.

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Early Disseminated Lyme Carditis Inducing High-Degree Atrioventricular Block

Case Reports in Cardiology ◽

10.1155/2020/5309285 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Connor C. Kerndt ◽

John A. Bills ◽

Zaid J. Shareef ◽

Alexander M. Balinski ◽

Daniel F. Summers ◽

...

Keyword(s):

Erythema Migrans ◽

The United States ◽

Outdoor Exposure ◽

Clinical Suspicion ◽

Adverse Outcomes ◽

Av Block ◽

Lyme Carditis ◽

High Degree ◽

Electrocardiogram Ecg

Lyme disease is the most common tick-borne illness in the United States due to Borrelia burgdorferi infection. This case demonstrates a 20-year-old male patient presenting with complaints of annular skin rash, malaise, fever, and lightheadedness after significant outdoor exposure. Physical exam revealed multiple large targetoid lesions on the back and extremities. The rash had raised borders and centralized clearing consistent with erythema migrans chronicum. Electrocardiogram (ECG) revealed a high-degree atrioventricular (AV) block. The patient was started on intravenous ceftriaxone due to clinical suspicion for Lyme carditis. ELISA and Western blot tests were reactive for Lyme IgM and IgG, confirming the diagnosis. The AV block resolved by hospital day four and the patient was discharged with outpatient follow-up. Early identification of disease allowed for effective treatment with no adverse outcomes or sequelae.

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Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block

10.20944/preprints201808.0078.v1 ◽

2018 ◽

Author(s):

Cynthia Yeung ◽

Adrian Baranchuk

Keyword(s):

Lyme Disease ◽

Risk Stratification ◽

Atrioventricular Block ◽

Systematic Approach ◽

Diagnosis And Treatment ◽

Av Block ◽

Diagnosis And Management ◽

Lyme Carditis ◽

High Degree ◽

Risk Stratification Score

Lyme carditis (LC) is a manifestation of the early disseminated stage of Lyme disease and often presents as high-degree atrioventricular (AV) block. High-degree AV block in LC can be treated with antibiotics, usually resolving with highly favourable prognosis, thus preventing the unnecessary implantation of permanent pacemakers. We present a systematic approach to the diagnosis and management of LC that implements the Suspicious Index in Lyme Carditis (SILC) risk stratification score.

Download Full-text