Electrocardiogram Abnormalities in Children With Lyme Arthritis

Area of Science:

• Pediatric Cardiology
• Infectious Diseases
• Rheumatology

Background:

• Lyme disease classically presents in stages, with carditis in early disseminated disease and arthritis in late stages.
• The intersection of clinical stages and the prevalence of electrocardiogram (ECG) abnormalities in pediatric Lyme arthritis are not well understood.
• This study addresses the knowledge gap regarding ECG changes in children diagnosed with Lyme arthritis.

Purpose of the Study:

• To determine the prevalence of ECG abnormalities in pediatric patients diagnosed with Lyme arthritis.
• To assess whether any clinical or laboratory features are associated with ECG abnormalities in this population.

Main Methods:

• Retrospective, cross-sectional study of pediatric patients with Lyme arthritis at a tertiary care children's hospital.
• Included patients diagnosed via 2-tiered serology with ECGs obtained within 2 days of antibiotic initiation.
• A cardiologist reviewed ECGs for carditis indicators: atrioventricular block, ST-T wave changes, QTc prolongation, accelerated junctional rhythm, or right bundle branch block.

Main Results:

• Of 233 patients with Lyme arthritis, 90 (38.6%) had ECGs performed.
• Five patients (5.6%) exhibited ECG abnormalities: 3 with first-degree atrioventricular block, 1 with QTc prolongation, and 1 with ST-T wave changes.
• No clinical or laboratory factors predicted ECG abnormalities, and all affected patients responded to oral antibiotics without significant cardiac sequelae.

Conclusions:

• ECG abnormalities are uncommon in pediatric Lyme arthritis and do not signify clinically significant cardiac disease.
• Findings do not support the routine use of ECG screening in asymptomatic children with Lyme arthritis.
• Further research may explore the long-term cardiac implications, if any, in this patient group.