Key result
In a 40-year-old male with Lyme carditis, high-degree atrioventricular block resolved completely with a 21-day course of antibiotic therapy, avoiding the need for a permanent pacemaker.
Case Report (n=1)
Lyme carditis should be considered in young patients with unexplained high-degree AV block, as prompt antibiotic therapy can resolve the conduction abnormality and prevent unnecessary pacemaker implantation.
Include LC in the differential for young patients with fluctuating high-degree AVB; case reports leave open optimal management strategies.
Lyme carditis (LC) is an early-disseminated manifestation of Lyme disease, most commonly presenting as a high-degree atrioventricular block (AVB). The degree of AVB can fluctuate rapidly within minutes, and progression to third-degree AVB is potentially fatal if not recognized and managed promptly. However, the AVB in LC is often transient and usually resolves with appropriate antibiotic therapy. LC should be on the differential diagnosis in young patients presenting with new high-degree AVB and factors that increase the index of suspicion for Lyme disease. The Suspicious Index in Lyme Carditis (SILC) score helps clinicians risk-stratify for LC. A systematic approach to the diagnosis and treatment of LC minimizes the unnecessary implantation of permanent pacemakers.
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Yeung et al. (2020) conducted a case report in Lyme carditis with high-degree atrioventricular block (n=1). Ceftriaxone followed by doxycycline was evaluated on Resolution of atrioventricular block. In a 40-year-old male with Lyme carditis, high-degree atrioventricular block resolved completely with a 21-day course of antibiotic therapy, avoiding the need for a permanent pacemaker.
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