Sažetak sa skupa

https://doi.org/10.15836/ccar2019.251

Total atrioventricular block in Lyme borreliosis

Jurica Petranović ; Požega General Hospital, Požega, Croatia
Rea Levicki ; Požega General Hospital, Požega, Croatia
Ivan Barišić ; Požega General Hospital, Požega, Croatia
Ile Raštegorac ; Požega General Hospital, Požega, Croatia
Vladimir Dujmović ; Požega General Hospital, Požega, Croatia
Darko Počanić ; University Hospital “Merkur”, Zagreb, Croatia

Sažetak

Introduction: Lyme disease is caused by the spirochete Borrelia Brugdorferi. It manifests as erythema
migrans but can also cause central neuropathy, arthritis and carditis.1 Cardiac manifestations include
conduction abnormalities with varying degrees of atrioventricular block and other rhythm disturbances.
2 The incidence of Lyme disease increases from west to east across Europe, with the highest
incidence in Slovenia (155/100 000).3
Case report: We observed a 32-year-old male patient who presented to the Emergency Department with
recurrent syncope. Electrocardiography recorded intermittent total atrioventricular block, with an average
heart rate of 25/min. A temporary pacemaker (Oscor Pace 101H, Single Chamber External Pacemaker)
was implanted emergently using right jugular access. He had been on Sovsko lake near Čaglin
village in Požega-Slavonia county 7 days prior to admittance, after which he had fever and chills for 2
days followed by diarrhea for 1 day. We started empirical treatment with intravenous ceftriaxone due
to suspected Lyme disease. No tick bites on skin were found.
Results: Results of serological testing showed that IgM Lyme titer (ELISA) was positive >5.23, also CLIA
IgM were positive (IgM >190, IgG >240), followed by positive IgM and IgG Western Blot. Considering these
results, we continued ceftriaxone treatment according to guidelines for 6 weeks. Echocardiography
demonstrated normal left and right ventricular systolic function with no valvular dysfunction. First
3 days continuous pacing was required, afterwards for 7 days only intermittent pacing in night hours
was required. In the end, the patient maintained normal sinus rhythm at 65-75 bpm. Two days after, the
external pacemaker and active fixation lead was removed.
Conclusion: Lyme borreliosis infection can cause conduction abnormalities, including total atrioventricular
block in structurally healthy heart. Conduction abnormalities are reversible with the use of
proper antibiotic treatment.

Ključne riječi

atrioventricular block; Lyme borreliosis.

Hrčak ID:

226718

URI

https://hrcak.srce.hr/226718

Datum izdavanja:

15.10.2019.

Posjeta: 705 *