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Harbinger of Lyme Carditis: From Atrioventricular Block to Atrial Fibrillation
Maryam Barkhordarian1, Mark Grijalva1, Avani Kolla1
1Hackensack Meridian Health-Palisades Medical Center, NJ, USA.
Journal of Community Hospital Internal Medicine Perspectives
|October 11, 2024
Summary
Lyme carditis, a complication of Lyme disease, can rarely cause atrial fibrillation. Early recognition of this atypical presentation is crucial for timely diagnosis and treatment of Lyme disease and its cardiac manifestations.
Area of Science:
- Cardiology
- Infectious Diseases
- Tick-borne Illnesses
Background:
- Lyme disease, caused by Borrelia burgdorferi, is transmitted by Ixodes ticks.
- Common symptoms include fever, headache, arthralgia, and erythema migrans.
- Untreated Lyme disease can lead to neuropathy and carditis, often presenting as high-degree atrioventricular block.
Observation:
- A 70-year-old male with hypertension and polycythemia vera presented with lightheadedness and bradycardia.
- Electrocardiogram revealed atrial fibrillation with regularized conduction at 40 bpm, indicating complete heart block and a junctional escape rhythm.
- Positive Lyme antibody tests (IgM and IgG) and echocardiogram findings of normal ejection fraction with moderate pulmonary hypertension were noted.
Findings:
- The patient was treated with antibiotics and anticoagulation.
- Due to persistent atrial fibrillation, cardioversion to sinus rhythm was performed.
- This case highlights a rare presentation of Lyme carditis involving atrial fibrillation.
Implications:
- Awareness of atypical cardiac presentations of Lyme carditis, such as atrial fibrillation, is essential for minimizing misdiagnosis.
- Testing for Lyme disease should be considered in patients with atrial fibrillation and AV block in the appropriate clinical context.
- Further research is needed to determine anticoagulation management in Lyme carditis patients who develop atrial fibrillation and subsequently achieve sinus rhythm.
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