Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block

Abstract

Lyme carditis (LC) is a manifestation of the early disseminated stage of Lyme disease and often presents as high-degree atrioventricular (AV) block. High-degree AV block in LC can be treated with antibiotics, usually resolving with highly favourable prognosis, thus preventing the unnecessary implantation of permanent pacemakers. We present a systematic approach to the diagnosis and management of LC that implements the Suspicious Index in Lyme Carditis (SILC) risk stratification score.

Suspicious index in Lyme carditis: Construction of a new risk model in the absence of guidelines

“…In fact, we address a systematic approach to the diagnosis and treatment of patients with highdegree AV block and serologically-confirmed LC in a separate recent publication. 3 While we do acknowledge that LC can also present as myocarditis, or even pancarditis, high-degree AV block is the most frequent manifestation, representing approximately 90% of LC. Thus, as stated explicitly in the paper, the focus of our systematic review is highdegree AV block.…”

A curious case of Lyme carditis in an urban hospital

“…[ 1 ] The Suspicious Index in Lyme carditis (SILC) score or COSTAR mnemonic was developed to help determine the likelihood that a patient’s AV block is due to LC [ 3 ]. Patients receive points for the presence of c onstitutional symptoms, engaging in o utdoor activity or being in an endemic area, male ( s ex) gender, t ick bite, a ge <50 years old and presence of erythema migrans ( r ash) [ 3 ]. Patients receiving a score of 0–2 is considered a low risk; 3–6 is an intermediate; and 7–12 is highly suspicious for LC [ 3 ].…”

“…Patients receive points for the presence of c onstitutional symptoms, engaging in o utdoor activity or being in an endemic area, male ( s ex) gender, t ick bite, a ge <50 years old and presence of erythema migrans ( r ash) [ 3 ]. Patients receiving a score of 0–2 is considered a low risk; 3–6 is an intermediate; and 7–12 is highly suspicious for LC [ 3 ]. Our patient had all these features and received a maximum score of 12 points.…”

Early Disseminated Lyme Carditis Inducing High-Degree Atrioventricular Block

“…After SILC scoring, individuals with low suspicion receive standard Case Reports in Cardiology treatment for AV block and those with intermediate or high suspicion begin empiric IV antibiotic therapy and serologic testing [15]. Patients exhibiting asymptomatic bradycardia are managed with strict cardiac monitoring [10,17], while symptomatic patients require continuous cardiac telemetry to evaluate the need for transcutaneous pacing or inotropic support due to the risk of ischemia or death with persistent high-grade AV block [13,[17][18][19].…”