Adjuvant Cilostazol Therapy to Help Restore Atrioventricular Conduction in Lyme Carditis

Lyme carditis commonly presents with varying degrees of atrioventricular (AV) conduction abnormalities.

A 41-year-old man presented with worsening fatigue, dizziness, and shortness of breath and a second-degree AV block. Laboratory testing confirmed an infection with Borrelia burgdorferi. The patient received intravenous ceftriaxone but remained in a 2:1 AV block. Addition of cilostazol, an oral phosphodiesterase-3 inhibitor that enhances nodal conduction, was associated with prompt restoration of AV conduction.

Adjunctive cilostazol may help restore conduction in select patients with higher-grade AV block. The effectiveness of this approach will need to be confirmed in prospective randomized studies. The case and rationale for this approach are discussed.

Lyme carditis should be suspected in younger patients with new AV block because timely recognition ensures that complete recovery after antibiotic therapy is initiated. By enhancing nodal conduction, cilostazol may reduce the need for temporary pacing and shorten hospitalization.