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Prospective evaluation of heart block complicating early Lyme disease
D A Rubin1, C Sorbera, P Nikitin
1Division of Cardiology and Infectious Diseases, Westchester County Medical Center, New York Medical College, Valhalla 10595.
Insights
Early Lyme disease rarely causes heart block. Prompt antibiotic treatment for Lyme disease, identified by erythema migrans rash, appears to prevent cardiac complications like heart block.
Area of Science:
- Cardiology
- Infectious Diseases
- Dermatology
Background:
- Lyme disease is a known cause of carditis and heart block.
- The prospective incidence of heart block in early Lyme disease remains unevaluated.
Purpose of the Study:
- To prospectively evaluate the incidence of carditis, specifically heart block, in patients with early Lyme disease.
- To assess the impact of antibiotic therapy on cardiac manifestations of Lyme disease.
Main Methods:
- Prospective evaluation of 61 patients diagnosed with early Lyme disease via erythema migrans.
- Serial examinations, including electrocardiographic parameters, were performed 3-4 weeks after antibiotic initiation for a subset of patients.
Main Results:
- Only 1.6% (1 of 61) of patients presented with heart block, which resolved with antibiotic treatment.
- No patients without initial heart block developed electrocardiographic changes or progressed to heart block after antibiotics.
Conclusions:
- Early Lyme disease infrequently presents with heart block.
- Early antibiotic administration is likely effective in preventing or resolving carditis and heart block in Lyme disease.
Abstract:
Lyme disease is a recognized cause of heart block/carditis. The incidence of heart block complicating early Lyme disease has not been prospectively evaluated. In this study, 61 patients with early Lyme disease documented by the rash of erythema migrans were prospectively evaluated for carditis. Fifty five of 61 patients had a repeat examination 3 to 4 weeks after initiation of antibiotic therapy. Only one of 61 patients (1.6%) presented with heart block, which resolved with antibiotics. None of the 54 patients without heart block on initial presentation had a change in any measured electrocardiographic parameter or progressed to heart block after antibiotics. Therefore, early Lyme disease appears to be infrequently complicated by heart block. Early administration of antibiotics may prevent the development of heart block/carditis.