Emergent pacemaker placement in a patient with Lyme carditis-induced complete heart block and ventricular asystole

Abstract

We report a case of a 31-year-old man who presented to the emergency department after four episodes of syncope within a 24 h time span. He was found to have symptomatic complete heart block associated with episodes of ventricular asystole lasting 5-6 s. He underwent emergent permanent pacemaker insertion during which he was found to have no underlying rhythm. He was later found to have positive serologies for Lyme disease despite no known exposure to ticks and neither signs nor symptoms of the disease. The pacemaker was ultimately removed due to resolution of his heart block with antibiotic therapy.

Suspicious index in Lyme carditis: Systematic review and proposed new risk score

“…Another 34 articles were removed for: not in English, not a case report/series, or not reporting high‐degree AVB . The final 74 articles reported on 88 cases relevant to this study ).…”

“…In six of these permanent pacemaker cases, the underlying AVB resolved after a course of antibiotics, and the pacemaker was removed or no longer required . In these cases, the pacemakers were implanted before the LC diagnosis was serologically confirmed . In the five remaining cases requiring permanent pacemaker implantation, the underlying heart block did not resolve despite antibiotic treatment .…”

“…Serological confirmation of Lyme infection (usually using enzyme‐linked immunosorbent assay and Western blot techniques) can confirm the diagnosis of LC . We suggest that a patient who presents with AVB and has an intermediate to high SILC score should be tested for serological evidence of LD and treated with antibiotics (±temporary‐permanent pacing for symptomatic bradycardia or strict cardiac monitoring for asymptomatic bradycardia).…”

“…However, in this review, 11 cases (12.5%) were implanted with permanent pacemakers in addition to antibiotics. In six of these permanent pacemaker cases, the underlying AVB resolved after a course of antibiotics, and the pacemaker was removed or no longer required . In these cases, the pacemakers were implanted before the LC diagnosis was serologically confirmed .…”

“…11,12 In these cases, the pacemakers were implanted before the LC diagnosis was serologically confirmed. [7][8][9][10][11][12] In the five remaining cases requiring permanent pacemaker implantation, the underlying heart block did not resolve despite antibiotic treatment. 8,[13][14][15] In 4 of these 5 cases, the pacemaker was placed after a course of antibiotics had not resolved the heart block.…”