Long-term Cardiac Sequelae in Lyme Carditis: A Review

Area of Science:

• Cardiology
• Infectious Diseases
• Immunology

Background:

• Lyme disease, caused by Borrelia burgdorferi, is a tick-borne illness prevalent in North America.
• Disseminated Lyme spirochetes can lead to multisystem complications, notably Lyme carditis, affecting the heart.

Purpose of the Study:

• To review the cardiovascular complications of Lyme carditis.
• To assess the prevalence, reversibility, and chronicity of cardiac involvement.
• To explore diagnostic and prognostic implications of Lyme carditis.

Main Methods:

• Review of observational studies, retrospective analyses, systematic reviews, and case reports.
• Inclusion of patients with confirmed or presumed Lyme carditis.
• Analysis of key outcomes including cardiac prevalence, reversibility, chronicity, and diagnostic/prognostic factors.

Main Results:

• Atrioventricular block is the most common abnormality (up to 90%), sometimes requiring pacing.
• Most conduction issues resolve with antibiotics, but some patients have persistent dysfunction.
• Structural issues like myocarditis, pericarditis, and rare endocarditis/cardiomyopathy occur; chronic inflammation and autoimmunity may cause long-term remodeling.
• Rare coronary artery involvement and aneurysms suggest chronic cardiovascular risk.

Conclusions:

• Lyme carditis can lead to persistent cardiovascular complications despite treatment.
• Permanent conduction abnormalities, myocarditis, and ventricular dysfunction are reported; chronic heart failure and coronary artery issues require more study.
• While often self-limited, Lyme carditis may have lasting cardiac effects, necessitating further research into risk factors, mechanisms, and long-term management.