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)80099-8

Cited by 30 publications

(5 citation statements)

References 3 publications

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“…Following a delayed diagnosis of Lyme myocarditis, our patient was started on intravenous antibiotics with an unfavorable course. Among patients treated in a timely fashion, heart block is typically resolved, with only a few rare cases describing persistent conduction disturbances 7, 8. The persistence of heart block in our patient and subsequent development of RV dilation and hypokinesis mandated ruling out sarcoidosis and arrhythmogenic right ventricular cardiomyopathy.…”

Section: Discussionmentioning

confidence: 72%

Lyme disease and cardiac sarcoidosis: Management of associated ventricular arrhythmias

Romero

Jorde

Díaz

et al. 2018

HeartRhythm Case Reports

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Section: Discussionmentioning

confidence: 72%

Lyme disease and cardiac sarcoidosis: Management of associated ventricular arrhythmias

Romero

Jorde

Díaz

et al. 2018

HeartRhythm Case Reports

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“…[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. 10,[13][14][15] In one case, the pacemaker was placed before LC was diagnosed.…”

Section: Clinical Course Of Lc Casesmentioning

confidence: 99%

“…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. 10,[13][14][15] In one case, the pacemaker was placed before LC was diagnosed. 8 Permanent pacemakers are rarely required, and should be limited to when AVB does not resolve after antibiotic treatment.…”

Section: Clinical Course Of Lc Casesmentioning

confidence: 99%

“…[14][15][16][17][18][19] All six low-scoring SILC cases lacked data on at least one of the SILC variables, and five of these lacked data on 3 or more SILC variables. [14][15][16][17]19 If all relevant data were available, the low-scoring SILC cases may have been categorized as higher-risk on the SILC scale. This proposed score has not been prospectively validated yet; therefore, before concluding on its value, it would be reasonable to apply SILC to a prospective series.…”

Section: Clinical Course Of Lc Casesmentioning

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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“…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: 99%

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 30 publications

References 3 publications

Lyme disease and cardiac sarcoidosis: Management of associated ventricular arrhythmias

Lyme disease and cardiac sarcoidosis: Management of associated ventricular arrhythmias

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

A young healthy male with syncope and complete heart block

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