Irreversible complete heart block in lyme disease

Artigao, R.; Torres, Gisela; Guerrero, Antonio; Jiménez-Mena, Manuel; Paredes, M.B.

doi:10.1016/0002-9343(91)90619-9

Cited by 11 publications

(11 citation statements)

References 3 publications

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“…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 ).…”

Section: Resultsmentioning

confidence: 99%

“…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 . In 4 of these 5 cases, the pacemaker was placed after a course of antibiotics had not resolved the heart block .…”

Section: Discussionmentioning

confidence: 99%

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

Besant

Wan

Yeung

et al. 2018

Clinical Cardiology

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Background Lyme carditis (LC), an early manifestation of Lyme disease that most commonly presents as high‐degree atrioventricular block (AVB), usually resolves with antibiotic treatment. When LC is not identified as the cause of AVB, a permanent pacemaker may be inappropriately implanted in a reversible cardiac conduction disorder. Hypothesis The likelihood that a patient's high‐degree AVB is caused by LC can be evaluated by clinical characteristics incorporated into a risk stratification tool. Methods A systematic review of all published cases of LC with high‐degree AVB, and five cases from the authors' experience, was conducted. The results informed the development of a new risk stratification tool, the Suspicious Index in LC (SILC) score. The SILC score was then applied to each case included in the review. Results Of the 88 cases included, 51 (58%) were high‐risk, 31 (35.2%) intermediate‐risk, and 6 (6.8%) low‐risk for LC according to the SILC score (sensitivity 93.2%). For the subset of 32 cases that reported on all SILC variables, 24 (75%) cases were classified as high‐risk, 8 (25%) intermediate‐risk, and 0 low‐risk (sensitivity 100%). Specificity could not be assessed (no control group). Notably, 6 of the 11 patients who received permanent pacemakers had reversal of AVB with antibiotic treatment. Conclusion The SILC risk score and COSTAR mnemonic (constitutional symptoms; outdoor activity; sex = male; tick bite; age < 50; rash = erythema migrans) may help to identify LC in patients presenting with high‐degree AVB, and ultimately, minimize the implantation of unnecessary permanent pacemakers.

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“…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 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Besant

Wan

Yeung

et al. 2018

Clinical Cardiology

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“…Permanent pacemaker therapy is therefore only indicated if the heart block fails to resolve after 6 weeks 9. However, this is exceedingly rare, as there are only two prior reports of patients requiring permanent pacemakers due to persistent AV block 17 18…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…20 However, permanent pacing is rarely, if ever required in instances of persistent heart block. 21 Heart block can persist up to 6 weeks and often resolves spontaneously, with no risk of recurrence in the future. 12 …”

Section: Treatment and Prognosismentioning

confidence: 98%

A young healthy male with syncope and complete heart block

Chauhan

et al. 2013

Scott Med J

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In at-risk individuals, clinicians should rule out this readily-treatable cause of heart block before proceeding with permanent pacemaker implantation due to enormous clinical and cost implications involved. Missing the diagnosis also exposes the patient to the risk of developing the late complications of Lyme disease. Diagnosis of isolated Lyme carditis is a challenge because the clinician does not have the diagnostic-clues that can usually be gleaned from the more common stigmata of Lyme disease.

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Irreversible complete heart block in lyme disease

Cited by 11 publications

References 3 publications

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

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

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

A young healthy male with syncope and complete heart block

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