Successful permanent pacemaker explantation after diagnosis and treatment of Lyme carditis complete heart block: a...

Area of Science:

• Cardiology
• Infectious Diseases
• Electrophysiology

Background:

• Lyme carditis (LC) causing complete heart block (CHB) typically resolves with antibiotics, often avoiding permanent pacemakers.
• The Suspicious Index in Lyme Carditis (SILC) score aids in diagnosing LC in patients with high-degree atrioventricular block.
• Spontaneous resolution of CHB in Lyme carditis is common, suggesting potential for pacemaker explantation.

Observation:

• A case of CHB occurred where a permanent pacemaker (PPM) was implanted before LC diagnosis.
• Initial SILC score was low (2), but later revised to intermediate (4) with positive Lyme serology.
• The patient received oral antibiotics and, after 2 months, showed minimal ventricular pacing (<0.1%), leading to pacemaker removal.

Findings:

• The patient recovered full conduction and the pacemaker was successfully removed.
• The patient has remained well for over a year post-explantation.
• This case demonstrates successful pacemaker removal in a patient treated for Lyme carditis.

Implications:

• Lyme carditis patients with CHB may not require permanent pacemakers if treated promptly.
• Patient selection for pacemaker explantation should consider established safe extraction parameters.
• The SILC score can help prevent unnecessary permanent pacemaker placement in future CHB cases of unclear etiology.