KEY POINTS
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Clinicians should be aware of the risk of Lyme carditis in patients presenting with atrioventricular (AV) block, especially those with a history of outdoor exposure in Lyme endemic areas, even if they do not endorse tick exposure or history of erythema migrans.
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Urgent electrocardiography shoud be obtained and antibiotics started early if there is suspicion of Lyme carditis, without waiting for serologic confirmation.
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In patients with suspected Lyme carditis, monitoring with telemetry for at least 24–48 hours should be considered and availability of transcutaneous pacing ensured in case of deterioration.
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Clinicians should recognize the potential for rapid progression of AV nodal block and symptomatic bradycardia, as well as sudden cardiac death in patients with Lyme carditis.