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Case Reports
. 2023 Nov 24;7(12):ytad576.
doi: 10.1093/ehjcr/ytad576. eCollection 2023 Dec.

Successful permanent pacemaker explantation after diagnosis and treatment of Lyme carditis complete heart block: a case report

Christopher R Messner  1 , Richard S Amara  2
Affiliations
Case Reports

Successful permanent pacemaker explantation after diagnosis and treatment of Lyme carditis complete heart block: a case report

Christopher R Messner et al. Eur Heart J Case Rep. .

Abstract

Background: Lyme carditis (LC) complete heart block (CHB) is typically treated with i.v. antibiotics without requiring permanent pacing. In patients with high degree atrioventricular (AV) block, suspicious index in Lyme carditis (SILC) scoring is highly sensitive for diagnosing LC.

Case summary: We present a case of CHB where a permanent pacemaker (PPM) was implanted prior to LC diagnosis. Suspicious index in Lyme carditis score was 2 at the time of exam, indicating a low risk for LC. However, per further discussion at follow-up, his score was retroactively increased to an intermediate risk of 4 and Lyme titres returned positive. An outpatient oral antibiotic regimen was given, and 2 months later, the patient had <0.1% V-pacing on interrogation with a subsequent unremarkable event monitor. The pacemaker was removed after considerations ensuring full conduction recovery. The patient is doing well at follow-up > 1 year.

Discussion: Lyme carditis spontaneous resolution of CHB is common. Once safe extraction parameters have been established, it is appropriate to engage patients without ongoing pacer requirements about explantation of their PPM. For CHB patients without clear aetiology, SILC scoring may be a predictive measure to help prevent unnecessary PPM placement in the future.

Keywords: Arrhythmias; Case report; Complete heart block; Lyme carditis; Pacemaker.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Presenting EKG. Complete heart block observed throughout warranting evaluation for implantation of permanent pacemaker.
Figure 2
Figure 2
Presenting telemetry strip. Complete heart block observed on telemetry strip in addition to EKG.
Figure 3
Figure 3
EKG prior to explantation. Conduction abnormality resolved after administration of outpatient antibiotic regimen.
See this image and copyright information in PMC

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