Incidence of carditis and predictors of pacemaker implantation in patients hospitalized with Lyme disease

Abstract

Background Lyme carditis, defined as direct infection of cardiac tissue by Borrelia bacteria, affects up to 10% of patients with Lyme disease. The most frequently reported clinical manifestation of Lyme carditis is cardiac conduction system disease. The goal of this study was to identify the incidence and predictors of permanent pacemaker implantation in patients hospitalized with Lyme disease. Methods A retrospective cohort analysis of the Nationwide Inpatient sample was performed to identify patients hospitalized with Lyme disease in the US between 2003 and 2014. Patients with Lyme carditis were defined as those hospitalized with Lyme disease who also had cardiac conduction disease, acute myocarditis, or acute pericarditis. Patients who already had pacemaker implants at the time of hospitalization (N = 310) were excluded from the Lyme carditis subgroup. The primary study outcome was permanent pacemaker implantation. Secondary outcomes included temporary cardiac pacing, permanent pacemaker implant, and in-hospital mortality. Results Of the 96,140 patients hospitalized with Lyme disease during the study period, 10,465 (11%) presented with Lyme carditis. Cardiac conduction system disease was present in 9,729 (93%) of patients with Lyme carditis. Permanent pacemaker implantation was performed in 1,033 patients (1% of all Lyme hospitalizations and 11% of patients with Lyme carditis-associated conduction system disease). Predictors of permanent pacemaker implantation included older age (OR: 1.06 per 1 year; 95% CI:1.05–1.07; P<0.001), complete heart block (OR: 21.5; 95% CI: 12.9–35.7; P<0.001), and sinoatrial node dysfunction (OR: 16.8; 95% CI: 8.7–32.6; P<0.001). In-hospital mortality rate was higher in patients with Lyme carditis (1.5%) than in patients without Lyme carditis (0.5%). Conclusions Approximately 11% of patients hospitalized with Lyme disease present with carditis, primarily in the form of cardiac conduction system disease. In this 12-year study, 1% of all hospitalized patients and 11% of those with Lyme-associated cardiac conduction system disease underwent permanent pacemaker implantation.

Prevalence of Lyme Carditis in Patients with Atrioventricular Blocks

“…It is estimated that cardiac involvement could be found in 1–4% of European patients with Lyme disease; however, systematically analyzed data in this field is lacking. The predominant LC presentation observed in 80–90% of patients usually includes the second- and third-degree atrioventricular blocks [ 3 , 4 ]. If this data is applied to Poland, approximately between 200 to 2500 Lyme disease patients could be expected to demonstrate advanced (>2nd degree) AVB.…”

“…Borrelia burgdorferi is increasingly noted as responsible for a considerable number of infection-related AVBs [ 2 ], and AVBs have been reported as the most common clinical presentation of LC (accounting for 80–90%) [ 3 , 4 ]. These blocks may potentially be resolved by an antibiotic therapy; therefore, the initial diagnosis of Borrelia infection may exert a significant impact on the therapeutic strategy in early pacemaker implantation.…”

Descriptive Data on Trends Among Patients Hospitalized With Lyme Disease in Southwest Michigan, 2017–2021

“…The early/localized stage of Lyme disease usually manifests as erythema migrans (EM) skin lesion(s), whereas once the condition progresses to the disseminated stage it may cause severe illness through complications that include carditis and central nervous system involvement (neuroborreliosis). Lyme carditis most frequently manifests as cardiac conduction disease, with myopericarditis and dilated cardiomyopathy also both observed occasionally [ 1 , 5 ]. Neuroborreliosis may cause a variety of neurologic manifestations that include facial palsy, meningitis, and a syndrome of painful subacute radiculitis that is often associated with lymphocytic pleocytosis and the aforementioned facial palsy (Bannwarth syndrome) [ 6 ].…”

“…Estimates of carditis rates among US Lyme inpatients are between 5% and 11% [ 5 , 8 , 9 ]. A single-center pediatric study [ 8 ] in Pennsylvania identified Lyme meningitis in 38% of pediatric patients hospitalized for Lyme disease from 2007 to 2014; I am not aware of similar data in US adults.…”

“…A single-center pediatric study [ 8 ] in Pennsylvania identified Lyme meningitis in 38% of pediatric patients hospitalized for Lyme disease from 2007 to 2014; I am not aware of similar data in US adults. In general, Lyme hospitalizations in the United States appear to be increasing [ 5 ]. The premise that Lyme carditis is increasing in incidence in the United States has been proposed in a pediatric setting [ 9 ].…”