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Case Reports
. 2018 Sep 2:2018:5265298.
doi: 10.1155/2018/5265298. eCollection 2018.

A Case of Lyme Carditis Presenting with Atrial Fibrillation

Peter J Kennel  1 , Melvin Parasram  2 , Daniel Lu  3 , Diane Zisa  1 , Samuel Chung  1 , Samuel Freedman  1 , Katherine Knorr  1 , Timothy Donahoe  1 , Steven M Markowitz  3 , Hadi Halazun  3
Affiliations
Case Reports

A Case of Lyme Carditis Presenting with Atrial Fibrillation

Peter J Kennel et al. Case Rep Cardiol. .

Abstract

We report a case of a 20-year-old man who presented to our institution with a new arrhythmia on a routine EKG. Serial EKG tracings revealed various abnormal rhythms such as episodes of atrial fibrillation, profound first degree AV block, and type I second degree AV block. He was found to have positive serologies for Borrelia burgdorferi. After initiation of antibiotic therapy, the atrial arrhythmias and AV block resolved. Here, we present a case of Lyme carditis presenting with atrial fibrillation, a highly unusual presentation of Lyme carditis.

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Figures

Figure 1
Figure 1
Baseline EKG. Normal sinus rhythm with a short PR interval.
Figure 2
Figure 2
EKG on admission shows coarse atrial fibrillation with a slow ventricular response. Whereas the tracings in the precordial leads to appear organized, the tracing in lead II suggests coarse atrial fibrillation.
Figure 3
Figure 3
Profound PR prolongation.
Figure 4
Figure 4
Abrupt change of PR intervals. Abrupt shift from relatively short PR to long PR (first line) and recurrent shift from long PR to shorter PR (last line). This second shift occurs after a PVC, which is a known phenomenon in which the PVC resets conduction to allow the fast pathway to conduct on the next beat.
Figure 5
Figure 5
After antibiotic therapy, resolution of AV block.
See this image and copyright information in PMC

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