Fatal Lyme carditis presenting as fluctuating high-grade atrioventricular block

Published Date
Journal
Canadian Medical Association Journal
Citation
192(21):E574-E577
DOI
10.1503/cmaj.191194. Epub 2020 May 24
Authors
Semproni M
Rusk R
Wuerz T
Abstract

KEY POINTS

  • 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.

  • Urgent electrocardiography shoud be obtained and antibiotics started early if there is suspicion of Lyme carditis, without waiting for serologic confirmation.

  • 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.

  • 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.