Electrocardiographic findings in children with Lyme disease
P K Woolf1, E M Lorsung, K S Edwards
1Department of Pediatric Cardiology, New York Medical College, Valhalla 10595.
Insights
Electrocardiographic abnormalities are common in children with Lyme disease (LD), even without cardiac symptoms. A 12-lead ECG can help screen for cardiac involvement in pediatric LD cases.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Clinical Electrophysiology
Background:
- Cardiac involvement in adults with Lyme disease (LD) is estimated at 4-10%, primarily affecting conduction and rhythm.
- Electrocardiographic (ECG) abnormalities are the most frequent manifestation of cardiac involvement in LD.
- The frequency of cardiac involvement in pediatric LD cases is not well-established.
Purpose of the Study:
- To determine the incidence of ECG abnormalities in children diagnosed with Lyme disease.
- To assess the utility of ECG as a screening tool for cardiac involvement in pediatric LD.
Main Methods:
- Prospective study involving 32 children with LD between May and September 1989.
- 12-lead electrocardiograms were performed on all participants.
- Patients were classified as definite or probable LD based on established diagnostic criteria.
Main Results:
- 29% of children with definite LD (4/14) exhibited ECG abnormalities, including AV block, left axis deviation, and ventricular ectopy.
- 30% of children with probable LD (3/10) showed abnormal ECG findings, such as ST-T wave changes and rhythm disturbances.
- No cardiac therapy was required for any patient, and no patient reported cardiac symptoms.
Conclusions:
- The incidence of ECG abnormalities in children with definite or probable LD is approximately 29%.
- First-degree atrioventricular block was the most common abnormality found.
- ECG may serve as a valuable screening tool for cardiac involvement when Lyme disease is suspected in children.
Abstract:
The incidence of cardiac involvement in Lyme disease (LD) has been estimated to be 4 to 10% in adults, with conduction and rhythm disturbances noted most frequently. To assess the frequency of electrocardiographic abnormalities in children with LD, we prospectively performed 12-lead electrocardiograms in 32 randomly selected children presenting with LD between May and September 1989. No patient had symptoms of cardiac involvement. Using defined diagnostic criteria, combining symptoms, signs, serology, and residence in or travel to an endemic area, 14 patients were classified as having definite LD and 10 were categorized as probable. The incidence of electrocardiographic abnormalities in the definite group was 29% (4/14), including two patients with 1 degree atrioventricular block, one with left axis deviation, and one with ventricular ectopy. Thirty percent (3/10) of the probable group had abnormal ECGs, including one with ST-T wave abnormalities, one with prominent sinus arrhythmia, sinus bradycardia, and wandering atrial pacemaker, and one with ectopic atrial bradycardia. No patient required cardiac therapy. The incidence of abnormal ECG findings in this group of children with either probable or definite LD was thus 29%, with 1 degree atrioventricular block noted most frequently. When the diagnosis of LD is highly suspected, an electrocardiogram may be a useful screening test for cardiac involvement.
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