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Incidence of Lyme Carditis and Lyme Carditis as a Cause of Pacemaker Implantation: A Nationwide Registry-Based
Sanna Avellan1,2, Kirsten Mehlig3, Josefina Robertson1,2
1Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
Insights
Lyme carditis (LC) is a rare cause of heart block requiring pacemakers. Despite being curable with antibiotics, over half of LC patients receive permanent pacemakers.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Lyme carditis (LC) is a cardiac manifestation of Lyme borreliosis (LB).
- LC often presents as high-grade atrioventricular block (AVB), frequently necessitating pacemaker implantation.
- The incidence of LC and its role in pacemaker implantation require systematic investigation.
Purpose of the Study:
- To determine the incidence of Lyme carditis (LC) in Sweden.
- To assess the incidence of LC as a cause for pacemaker implantation.
- To evaluate the risk of permanent pacemaker implantation in LC patients.
Main Methods:
- A case-control study utilizing Swedish national registers.
- Part 1: Patients diagnosed with AVB (2001-2018). Part 2: Patients receiving pacemakers for AVB (2010-2018).
- LB diagnosis within 90 days before or 180 days after AVB diagnosis, compared to matched general population controls.
Main Results:
- Of 81,063 AVB patients, 102 had LB. Yearly LC incidence was 0.056/100,000 adults.
- Of 25,241 pacemaker patients for AVB, 31 had LB. Yearly LC incidence for pacemaker implantation was 0.033/100,000 adults.
- The estimated risk for LC patients to receive a permanent pacemaker was 59%.
Conclusions:
- Lyme carditis is an uncommon cause of AVB.
- A significant proportion of LC patients (over 50%) receive permanent pacemakers.
- Despite being treatable with antibiotics, LC can lead to unnecessary pacemaker implantation.
Background:
Lyme borreliosis (LB) of the heart is called Lyme carditis (LC), which often manifests with high-grade atrioventricular block (AVB) requiring pacemaker implantation. LC is treated with antibiotics, and most patients recover fully after treatment. The overall incidence of LC, and of LC as a cause of pacemaker implantation, has not previously been systematically studied.
Methods:
This was a case-control study based on data from Swedish national registers. The study was divided into two parts; part 1 including all patients diagnosed with AVB between 2001 and 2018, and part 2 including all patients who had received a pacemaker due to AVB between 2010 and 2018. Patients diagnosed with LB 90 days before and 180 days after the AVB diagnosis were identified among the patients and compared to matched control groups generated from the general population.
Results:
Of 81 063 patients with AVB, 102 were diagnosed with LB. In the control group, 27 were diagnosed with LB. The yearly incidence of LC was 0.056 per 100 000 adults and year. Of 25 241 patients who had received a pacemaker for AVB, 31 were diagnosed with LB. In the control group, 8 were diagnosed with LB. The yearly incidence of LC as a cause of pacemaker implantation was 0.033 per 100 000 adults and year. The estimated risk for patients with LC to receive a permanent pacemaker was 59%.
Conclusions:
LC is a rare cause of AVB. Nevertheless, more than half of patients with LC receive a permanent pacemaker for a condition that is easily cured with antibiotics.
