Background
Lyme carditis (LC), an early manifestation of Lyme disease that most commonly presents as high‐degree atrioventricular block (AVB), usually resolves with antibiotic treatment. When LC is not identified as the cause of AVB, a permanent pacemaker may be inappropriately implanted in a reversible cardiac conduction disorder.
Hypothesis
The likelihood that a patient's high‐degree AVB is caused by LC can be evaluated by clinical characteristics incorporated into a risk stratification tool.
Methods
A systematic review of all published cases of LC with high‐degree AVB, and five cases from the authors' experience, was conducted. The results informed the development of a new risk stratification tool, the Suspicious Index in LC (SILC) score. The SILC score was then applied to each case included in the review.
Results
Of the 88 cases included, 51 (58%) were high‐risk, 31 (35.2%) intermediate‐risk, and 6 (6.8%) low‐risk for LC according to the SILC score (sensitivity 93.2%). For the subset of 32 cases that reported on all SILC variables, 24 (75%) cases were classified as high‐risk, 8 (25%) intermediate‐risk, and 0 low‐risk (sensitivity 100%). Specificity could not be assessed (no control group). Notably, 6 of the 11 patients who received permanent pacemakers had reversal of AVB with antibiotic treatment.
Conclusion
The SILC risk score and COSTAR mnemonic (constitutional symptoms; outdoor activity; sex = male; tick bite; age < 50; rash = erythema migrans) may help to identify LC in patients presenting with high‐degree AVB, and ultimately, minimize the implantation of unnecessary permanent pacemakers.
Lyme carditis may be an early manifestation of Lyme diseaseLyme disease is a tick-borne bacterial infection (mainly Borrelia burgdorferi) with endemic regions predominantly along the Canada-United States border. In 2016, 987 cases of Lyme disease were reported in Canada. 1 The heart is involved in up to 10% of Lyme disease cases, with the development of cardiac tissue inflammation or Lyme carditis. 2 Nearly all patients with Lyme carditis (90%) will have atrioventricular block, 3 which commonly presents with breathlessness, palpitations, dizziness or syncope. 2
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