High-grade Atrioventricular Block Due to Disseminated Lyme Disease Requiring Permanent Pacemaker Implantation

Lyme carditis is an uncommon manifestation of disseminated Lyme disease, most frequently presenting as fluctuating atrioventricular block (AVB). We report the case of a middle-aged man with history of frequent deer hunting in a Lyme-endemic region who presented with fatigue and malaise. Skin examination revealed erythema migrans, and the patient had electrocardiographic findings of atrial flutter with high-degree AVB, along with long sinus pauses on telemetry. IV ceftriaxone was started, and subsequent serologic testing confirmed Borrelia burgdorferi infection. Despite appropriate antibiotic therapy, AVB persisted, necessitating permanent pacemaker implantation. This case highlights the importance of early recognition of Lyme carditis, the need for continued cardiac monitoring, and the occasional need for permanent pacemaker implantation in some patients.