Junctional ectopic tachycardia secondary to myocarditis associated with sudden cardiac arrest

Cunningham, Michael E.; Doroshow, Robin Winkler; Olivieri, Laura; Moak, Jeffrey P.

doi:10.1016/j.hrcr.2016.09.015

Cited by 10 publications

(12 citation statements)

References 12 publications

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“…The two-tier antibody-based test recommended by the CDC is highly specific but has poor sensitivity [59]. Supplementary studies that have been used in the diagnosis include echocardiography [7, 57, 60], gadolinium enhanced cardiac MRI [16, 27], endo-myocardial biopsy [6, 7, 22, 61, 62] with special staining [3, 4, 8, 40], culture [3] or electron microscopy [7, 61–63], Ga67 Scan [64–66], and Indium 111 labelled anti-myosin antibody scintigraphy [4]. Histology of affected cardiac tissue shows infiltration predominantly with lymphocytes and plasma cells [15, 22, 29, 40].…”

Section: Discussionmentioning

confidence: 99%

“…A pediatric study of patients with Lyme disease found ECG changes in 29% [21]. LC could result in acute heart failure [22, 23], cardiogenic shock [23, 24], cardiac arrest [25–27], or sudden cardiac death [15, 28, 29]. We report a case of exercise induced progression of first-degree heart block to high degree AV block, with complete resolution on cessation of exercise, which could be reproduced.…”

Section: Introductionmentioning

confidence: 99%

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First case report of inducible heart block in Lyme disease and an update of Lyme carditis

2019

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Background Lyme disease (LD), is the most common vector-borne illness in the US and Europe, with predominantly cutaneous, articular, cardiac and neuro-psychiatric manifestations. LD affects all layers of the heart and every part of the conducting system. Carditis is a less common manifestation of LD. Heart block (HB) as the initial and sole manifestation of LD is rare. Inducible HB has never been reported in LD. We report a case of heart block (HB) inducible with exercise and reversible with rest. Case presentation A 37-year-old male presented to the emergency department after experiencing two episodes of syncope while at work. He presented, with a heart rate of 57 bpm, and the ECG showed sinus bradycardia with first degree AV block. The PR interval was 480 ms (NL 120–200 ms). Physical exam was unremarkable. The cardiologist’s initial impression was vaso-vagal attack. He developed high degree AV block during a stress test for the initial work up, which resolved on cessation of exercise. A similar episode while walking in the hallway, resolved at rest. The high degree AV block appeared inducible with exercise and reversible with rest. His Lyme serology was strongly positive. He was treated with ceftriaxone and doxycycline. After completing treatment, the patient had a normal ECG and returned to work without limitations, doing manual labor. Conclusions Manifestations of Lyme carditis (LC) vary from asymptomatic and symptomatic electrocardiographic changes and heart block (HB) reversible with treatment, to sudden death. HB as the sole and initial presentation of LC is rare. There have been no reports of inducible HB in LD. Here we present a case of inducible and reversible high degree HB in a case of LC and an update of literature. Exercise and stress testing should be avoided in suspected cases of LC until resolution of carditis. Lyme carditis should be suspected in individuals with cardiac manifestations in an endemic area, particularly in the younger patients with no other etiology evident.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

First case report of inducible heart block in Lyme disease and an update of Lyme carditis

2019

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“…Moreover, JET may be a sign for the return of normal sinus rhythm after treatment of Lyme disease. 11…”

Section: Pathophys Iologymentioning

confidence: 99%

Junctional ectopic tachycardia (JET)

Alasti

Mirzaee

Machado

et al. 2020

Journal of Arrhythmia

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Junctional Ectopic Tachycardia (JET) is a tachyarrhythmia arising from the atrioventricular node and His bundle area. It is also called junctional tachycardia, focal junctional tachycardia, or junctional nonreentrant tachycardia. Heart rate in JET should be more than 95 th percentile of heart rate for age (typically more than 100 beats per minute in adults); otherwise, it is called accelerated junctional rhythm. 1-3 JET is more common in children and may be congenital or acquired in postoperative settings. JET is a rare arrhythmia in adults and the pathogenesis is not completely understood. Moreover, because its clinical and electrocardiographic presentation varies, the diagnosis is challenging, and it can be easily mistaken for more common arrhythmias like atrioventricular nodal reentrant tachycardia (AVNRT). 1,4-5 2 | CLINI C AL FE ATURE S This arrhythmia can be categorized as primary JET, without a clear predisposing factor, or secondary JET, which occurs in a clinical condition. Primary JET occurs as congenital form or as sporadic cases in children and adults. Congenital JET occurs within the first 6 months of age, usually presents at birth, and is associated with high morbidity and mortality. It is an arrhythmia with mean ventricular rates of 200 to 250 beats/min and is associated with a high incidence of ventricular systolic dysfunction and clinical heart failure. Prenatal cases may present with hydrops. 1 When it occurs after the age of 6 months, the clinical course is not malignant. Indeed, a similar clinical course to other supraventricular tachycardias has been reported in adults and the main symptom in these patients is palpitations with exacerbation during physical

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“…3 LC is caused by direct invasion of myocardial tissue by spirochetes and an immunological host response causing lymphocyte inflammation. B. burgdorferi has a predisposition to cause inflammation of the atrioventricular (AV) node resulting in variable conduction abnormalities which can be seen in electrocardiograms (ECGs/EKGs), 4 such as atrioventricular conduction abnormalities (most common), right bundle branch block (RBBB), and left bundle branch block (LBBB). 3 Furthermore, cases of LC with widening of the QRS complex, AV dissociation, atrial fibrillation, ventricular dysfunction, fulminant myocarditis, and even cardiac arrest have been described.…”

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confidence: 99%

“…3 Furthermore, cases of LC with widening of the QRS complex, AV dissociation, atrial fibrillation, ventricular dysfunction, fulminant myocarditis, and even cardiac arrest have been described. 3–5 While LC is not commonly present during early LD, disseminated EM and LC may present concurrently within two weeks of tick attachment. 6 Furthermore, single EM concomitantly with an AV block has been also reported.…”

mentioning

confidence: 99%