A Case of Lyme Carditis Presenting with Atrial Fibrillation

Abstract

We report a case of a 20-year-old man who presented to our institution with a new arrhythmia on a routine EKG. Serial EKG tracings revealed various abnormal rhythms such as episodes of atrial fibrillation, profound first degree AV block, and type I second degree AV block. He was found to have positive serologies for Borrelia burgdorferi. After initiation of antibiotic therapy, the atrial arrhythmias and AV block resolved. Here, we present a case of Lyme carditis presenting with atrial fibrillation, a highly unusual presentation of Lyme carditis.

Lyme carditis presenting as atrial fibrillation

“…A rare number of cases surrounding young 20-year-old male patients have been described in the literature or anecdotally to present with atrial fibrillation, all of which had a favourable outcome after completion of antibiotic treatment 5 12. Varying degrees of AVB minutes to hours apart are also unusual such as in our patient who presented with atrial fibrillation, second-degree Mobitz I heart block and profound first-degree heart block.…”

“…All cases of Lyme disease are reportable to state and local health departments. Approximately 26 000 persons are diagnosed with Lyme disease in the USA each year 5. Rates of Lyme disease have increased disproportionately among young men for unknown reasons with a male predominance of 3 to 1 6 7…”

The association between the acquisition of antibodies against Lyme disease and the risk of atrial arrhythmias

“…Moreover, there is no available report on the long-term risk of SA in patients with LD and elevated levels of NT-proBNP. There are only a few cases of AF, which presented as LC [7,[18][19], probably due to the effect of sudden and advanced conduction disorders. Only one study has assessed the prevalence of Borrelia infection in patients with AF [5].…”

“…Cardiac manifestations of LC can occur after a median of 21 days from the onset of tick exposure [6]. The most common clinical feature of LC is transient atrioventricular (AV) block (90%), occurring mainly above the bundle of His [6][7]. The true incidence of LC may be underestimated as case reports have documented abnormalities ranging from first-degree heart block to myocarditis and acute heart failure [8][9][10].…”

Lyme carditis presenting as atrial fibrillation in a healthy young male

“…Only 1% of the patients with Lyme disease have cardiovascular manifestations and 54% of those have high-degree AV block 2. AF is an extremely rare presentation of Lyme carditis with fewer than five cases published in the English literature 3 4…”