Fatal Lyme carditis presenting as fluctuating high-grade atrioventricular block
Canadian Medical Association Journal
10.1503/cmaj.191194. Epub 2020 May 24
Semproni M, Rusk R, Wuerz T
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.