Lyme carditis manifesting with sinoatrial exit block: a case report

Abstract

Background Lyme disease is the most common vector-borne disease in North America and Europe. Infection with the spirochete Borrelia burgdorferi complex can involve cardiac tissue causing Lyme carditis (LC). Due to affection of conductive tissue, LC typically presents with varying degrees of atrioventricular conduction block. Here, we provide first evidence that conductive tissue of the sinus node can be involved in LC resulting in higher degree SA block with concomitant syncope. Case summary We report the case of an otherwise healthy 31-year-old female presenting with LC manifesting with sinoatrial (SA) exit block causing asystole over 12 seconds with concomitant syncope. Signs of SA block completely resolved with antibiotic treatment with a third-generation cephalosporin. The patient did not require permanent pacemaker implantation and had no sinus pauses after six months follow-up as confirmed via implantable loop recorder. Conculsion The possibility of LC in patients with sinus node dysfunction should be considered, as adequate antibiotic therapy can spare patients from potentially unnecessary pacemaker implantation.

Cardiac Sarcoidosis—Diagnostic and Therapeutic Challenges

“…These conditions include myocarditis, various conduction system diseases, genetic cardiomyopathies, and ischemic heart disease. Lyme carditis [85], giant cell myocarditis, and genetic cardiomyopathies such as laminopathies may all present with conduction system disease [21,33,86]. Notably, giant cell myocarditis (GCM) is a rare, but important phenocopy.…”