Key result
Late-stage Lyme disease is linked to greater autonomic dysfunction and reduced HRV versus healthy controls.
Why the study?
Is late-stage Lyme disease associated with cardiovascular autonomic dysfunction compared to healthy controls?
Cross-Sectional (n=324)
Is late-stage Lyme disease associated with cardiovascular autonomic dysfunction compared to healthy controls?
Late-stage Lyme disease is associated with significant cardiovascular autonomic dysfunction, including impaired heart rate variability and baroreflex sensitivity, indicating a need for comprehensive autonomic evaluation in these patients.
Late-stage Lyme may warrant autonomic evaluation; hypothesis-generating and requires prospective confirmation before practice change.
Lyme disease, caused by Borrelia burgdorferi sensu lato, may lead to persistent complications, including autonomic nervous system dysfunction. Although postural orthostatic tachycardia syndrome is frequently associated with orthostatic intolerance in Lyme disease, broader autonomic impairment remains insufficiently characterized. This cross-sectional study included 324 participants: 233 patients with late-stage Lyme disease and 91 healthy controls. All participants underwent cardiovascular autonomic reflex testing, beat-to-beat heart rate variability analysis, baroreflex assessment, 24-hour Holter electrocardiography, and ambulatory blood pressure monitoring. Compared with controls, patients with Lyme disease demonstrated significantly higher rates of sympathetic and parasympathetic dysfunction (p<0.05). Heart rate variability spectral parameters, including very low frequency, low frequency, and high frequency components, were significantly reduced, while baroreflex sensitivity and baroreflex effectiveness index were also impaired (p<0.05). Holter monitoring additionally revealed reduced time-domain heart rate variability parameters and an elevated low-frequency/high-frequency ratio, suggesting relative sympathetic predominance in patients with Lyme disease (p<0.05). These findings support the presence of cardiovascular autonomic dysfunction in patients with late-stage Lyme disease and highlight the importance of comprehensive autonomic evaluation in this population.
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Milovanovic et al. (2026) conducted a cross-sectional in Late-stage Lyme disease (n=324). Late-stage Lyme disease vs. Healthy controls was evaluated on Sympathetic and parasympathetic dysfunction (p=<0.05). Late-stage Lyme disease was associated with significantly higher rates of sympathetic and parasympathetic dysfunction and reduced heart rate variability compared with healthy controls (p<0.05).
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