Lyme carditis presenting as atrial fibrillation in a healthy young male

Abstract

We present a case of a 23-year-old man coming with palpitations, found to be in atrial fibrillation (AF). He was initially managed with metoprolol for rate-controlled therapy—reverted to normal sinus rhythm and discharged home. He returned a few days later—this time in varying degrees of atrioventricular block including transient complete heart block. He was empirically started on intravenous ceftriaxone for suspected Lyme carditis, which subsequently led to the resolution of high-degree heart block. Lyme immunoglobulin G (IgG) and IgM returned positive. Follow-up ECG after the course of antibiotic exhibited normal sinus rhythm. AF is a rare presentation of Lyme disease but still exists. It should be considered in terms of appropriate treatment, especially in Lyme-endemic areas.

A Case of Reversible Dementia? Dementia vs Delirium in Lyme Disease

“…No clear cardiac condition or gait disturbance was reported in the patient’s medical history, which sometimes occurs in Lyme disease. 2 , 5 , 6 )…”

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].…”

“…LD is primarily a clinical diagnosis, and serological analysis is, thus, supportive in the diagnostic process [21]. Antibiotic therapy can be used even without waiting for antibody test results in patients with new-onset AF with high-degree AV block in endemic regions for LC, which may even prevent the need for an implantable pacemaker for these patients [7,[18][19].…”

“…However, false-positive results are common in LD-endemic areas where seropositivity rates may be even 4-5% among the general population [4]; thus, the relevance to clinical disease is questionable [18]. Approximately 40% of patients who develop LC will have an erythema migrans rash compared to 70% of patients with other LD manifestations [17,19]. This means that approximately 60% of patients have no noticeable symptoms.…”