Pacemaker Explantation in Patients With Lyme Carditis

Wamboldt, Rachel; Wang, Chang; Miller, Jennifer C.; Enríquez, Andrés; Yeung, Cynthia; Chacko, Sanoj; Foisy, Melanie; Baranchuk, Adrián

doi:10.1016/j.jaccas.2022.02.012

Cited by 5 publications

(2 citation statements)

References 14 publications

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“…Apart from use of antibiotics, one algorithm discussed use of pacemaker implantation and subsequent explantation. Pacemaker implantation is common for symptomatic bradycardia, especially with high-grade AV blocks, as these are associated with cardiac arrest [7,98]. In Lyme carditis, brief periods of asystole are associated with a worse prognosis, along with escape rhythms featuring a wide QRS complex and fluctuating bundle branch blocks [99].…”

Section: Discussionmentioning

confidence: 99%

Associations of Atrioventricular Blocks and Other Arrhythmias in Patients with Lyme Carditis: A Systematic Review and Meta-Analysis

Javed,

Sklyar,

Bella

2024

JCDD

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Lyme disease often leads to cardiac injury and electrophysiological abnormalities. This study aimed to explore links between atrioventricular blocks and additional arrhythmias in Lyme carditis patients. This systematic review and meta-analysis of existing literature was performed from 1990 to 2023, and aimed to identify cases of Lyme carditis through serology or clinical diagnosis with concomitant arrhythmias. Pubmed and Web of Science were searched using appropriate MESH terms. Patients were divided into groups with atrioventricular blocks and other arrhythmias for cardiovascular (CV) outcome assessment. A total of 110 cases were analyzed. The majority (77.3%) were male, with mean age = 39.65 ± 14.80 years. Most patients presented within one week of symptom onset (30.9%). Men were more likely to have first-degree atrioventricular blocks (OR = 1.36 [95% CI 1.12–3.96], p = 0.01); these blocks tended to be reversible in nature (OR = 1.51 [95% CI 1.39–3.92], p = 0.01). Men exhibited a higher likelihood of experiencing variable arrhythmias (OR = 1.31 [95% CI 1.08–2.16], p < 0.001). Ventricular and supraventricular arrhythmias were more likely to exhibit instability (OR = 0.96 [95% CI 0.81–1.16] p = 0.01) and variability (OR = 1.99 [95% CI 0.47–8.31], p < 0.001). Men with Lyme carditis are likely to present with various atrioventricular blocks. These atrioventricular blocks are benign, and follow a predictable and stable clinical course. Further large-scale studies are warranted to confirm these associations.

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Section: Discussionmentioning

confidence: 99%

Associations of Atrioventricular Blocks and Other Arrhythmias in Patients with Lyme Carditis: A Systematic Review and Meta-Analysis

Javed,

Sklyar,

Bella

2024

JCDD

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“…Recently, a study commented on a 59-year-old male patient presenting with CHB who received a PPM, SILC = 4, who was also treated with doxycycline 100 mg orally twice daily for 3 weeks and found to have resolution of heart block, with pacemaker explant at 42 weeks. 11 …”

Section: Discussionmentioning

confidence: 99%

Successful permanent pacemaker explantation after diagnosis and treatment of Lyme carditis complete heart block: a case report

Messner,

Amara

2023

European Heart Journal - Case Reports

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Background Lyme carditis (LC) complete heart block (CHB) is typically treated with i.v. antibiotics without requiring permanent pacing. In patients with high degree atrioventricular (AV) block, suspicious index in Lyme carditis (SILC) scoring is highly sensitive for diagnosing LC. Case summary We present a case of CHB where a permanent pacemaker (PPM) was implanted prior to LC diagnosis. Suspicious index in Lyme carditis score was 2 at the time of exam, indicating a low risk for LC. However, per further discussion at follow-up, his score was retroactively increased to an intermediate risk of 4 and Lyme titres returned positive. An outpatient oral antibiotic regimen was given, and 2 months later, the patient had <0.1% V-pacing on interrogation with a subsequent unremarkable event monitor. The pacemaker was removed after considerations ensuring full conduction recovery. The patient is doing well at follow-up > 1 year. Discussion Lyme carditis spontaneous resolution of CHB is common. Once safe extraction parameters have been established, it is appropriate to engage patients without ongoing pacer requirements about explantation of their PPM. For CHB patients without clear aetiology, SILC scoring may be a predictive measure to help prevent unnecessary PPM placement in the future.

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