Lyme Carditis Presenting with High-degree Atrioventricular Block: A Systematic Review

Treating Lyme carditis high‐degree AV block using a temporary–permanent pacemaker

“…Diagnosis often proves to be challenging as many patients do not remember a previous exposure to tick bites and do not have EM. The use of the Suspicious Index in Lyme Carditis (SILC) score (Besant et al, ) may help identifying Lyme carditis (Table ). In this case report, we describe a different technique to transiently pace the heart using temporary–permanent pacing (TPP) during symptomatic bradycardia associated with Lyme carditis.…”

Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block

“…In order to evaluate the likelihood that a patient's high-degree heart block is caused by LC, we proposed the Suspicious Index in Lyme Carditis (SILC) score ( Table 1). [22] This novel risk score assigns weights to the following risk factors: age < 50; [5,6,19] male sex (compared to relatively equal prevalence of Lyme disease by sex, LC has a strong male predominance of approximately 3:1); [2] outdoor activity or endemic area; [2,23] characteristic symptoms of Lyme disease, including fever, malaise, arthralgia, dyspnea, pre-syncope, and syncope; [4,24] history of a tick bite; [19] and erythema migrans. [6] In a preliminary validation study, the SILC risk stratification tool had a sensitivity of 93.2%.…”

“…[6] In a preliminary validation study, the SILC risk stratification tool had a sensitivity of 93.2%. [22] 1 2 3 4 1 Fever, malaise, arthralgia, dyspnea, pre-syncope, and syncope…”

Systematic Approach to the Diagnosis and Treatment of Lyme Carditis and High-Degree Atrioventricular Block

“…In order to evaluate the likelihood that a patient’s high-degree heart block is caused by LC, we proposed the Suspicious Index in Lyme Carditis (SILC) score (Table 1) [22]. This novel risk score assigns weights to several risk factors: age < 50 [5,6,19]; male sex [2]; outdoor activity or endemic area [2,23]; constitutional symptoms of Lyme disease, including fever, malaise, arthralgia, dyspnea, pre-syncope, and syncope [4,24]; history of a tick bite [19]; and erythema migrans [6].…”

“…A preliminary validation study in which the SILC risk stratification tool was retrospectively applied to 88 cases of LC (83 from a systematic review of all published cases of LC with high degree AV block and five from our own experience) demonstrated a sensitivity of 93.2% (if a variable was not available, it was conservatively assigned a zero). The sensitivity increased to 100% when the SILC score was applied to cases that reported on all SILC variables ( n = 32) [22].…”