Lyme Carditis Presenting as Sinus Node Dysfunction and Accelerated Junctional Rhythm

Abstract

Lyme disease can have cardiac involvement and can subsequently present with various types of atrio ventricular (AV) block. Sinus node dysfunction (SND) and accelerated junctional rhythm are highlighted in this case as an uncommon presentation for Lyme Carditis. This case highlights the importance of having a high index of suspicion for cardiac involvement with Lyme disease when atypical arrhythmias are present.

Lyme carditis presenting with accelerated junctional rhythm in an adult patient

“…There is 1 case report of a 54-year-old patient with Lyme carditis and sinus node dysfunction with a junctional escape rhythm. 8 …”

Lyme carditis and accelerated junctional rhythm with intermittent left bundle branch block and paroxysmal atrioventricular block

“…The searches yielded 8 publications describing 10 patients. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 The primary search of PubMed retrieved 30 initial articles, of which 4 articles were identified for the review. 4 , 9 , 10 , 11 The secondary search retrieved 4 additional articles.…”

“… 4 , 9 , 10 , 11 The secondary search retrieved 4 additional articles. 5 , 6 , 7 , 8 One article, an abstract, described a presenting heart rate of 50 beats/min but designated the arrhythmia as accelerated junctional rhythm. 6 The final patients, with the patient from this article listed as case 8 under accelerated junctional rhythm, are listed in Table 1 .…”

“… 4 , 8 , 9 , 10 Outpatient antibiotics were not described in 2 other patients, in whose cases only IV ceftriaxone was reported. 5 , 11 One patient received oral doxycycline and refused hospitalization for IV antibiotics owing to insurance issues. 6 Another patient was prescribed oral doxycycline owing to misinterpretation of the initial ECG and had resolution of complete AV block with a normal ECG by the time IV antibiotics were considered 2 weeks later.…”