Lyme carditis in Europe

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• Lyme borreliosis is Europe's most common tick-borne illness, caused by *Borrelia burgdorferi sensu lato*.
• Lyme carditis, though uncommon, is a significant extracutaneous manifestation due to potential rapid progression of atrioventricular conduction disease.
• European Lyme borreliosis epidemiology differs from North America, with predominant species *B. afzelii* and *B. garinii*.

Purpose of the Study:

• To review European evidence on the microbiological, epidemiological, diagnostic, and surveillance aspects of Lyme carditis.
• To highlight challenges in diagnosing Lyme carditis in the European context.
• To propose improvements for European surveillance systems.

Main Methods:

• Synthesis of European evidence on Lyme carditis.
• Analysis of microbiological, epidemiological, diagnostic, and surveillance data.
• Review of diagnostic complexities and proposed surveillance strategies.

Main Results:

• Lyme carditis is rare in treated Lyme borreliosis cases but significant in unexplained atrioventricular block.
• Diagnosis is challenging due to non-specific symptoms, early seronegativity, and limited diagnostic tools.
• European surveillance systems vary, complicating data collection and comparison.

Conclusions:

• Enhanced surveillance incorporating cardiology-linked pathways is crucial for timely diagnosis and management.
• Standardized case definitions and multicenter collaboration are needed to improve incidence data and diagnostic algorithms.
• Clarifying the role of specific European *Borrelia* species in cardiac involvement is essential.