Multiple cardiac arrests due to Lyme carditis

Abstract

The most common form of Lyme carditis (LC) are different types of conduction abnormalities, especially atrioventricular (A-V) blocks. In most cases the course of the disease is benign and when the patient is diagnosed and treated appropriately, even the most advanced forms of A-V block typically resolve within one week. Implantation of a permanent pacemaker is only exceptionally necessary. We present a case of a patient with multiple cardiac arrests due to advanced A-V block. Despite the proper diagnosis of LC and targeted antibiotic therapy, the patient was completely dependent on temporary endocavitary pacing for more than one week. Finally, implantation of a permanent pacemaker was decided, however, during the next three months, A-V conduction abnormalities gradually subsided. This made us doubt whether the decision about implantation wasn’t made prematurely. The solution came at a one-year follow-up visit when it turned out that ventricular stimulation reappeared. We believe, that if A-V conduction disturbances in the course of Lyme disease persist for more than a week despite targeted antibiotic therapy, it is most likely a sign of serious and irreversible damage to the structures of the A-V node.