Lyme carditis patients may require temporary permanent pacemaker

Lyme carditis can cause atrioventricular (AV) block, which may present with varying degrees of severity. Some of these patients may require a pacemaker but doctors are typically reluctant to prescribe a permanent pacemaker, since symptoms will often resolve with antibiotic treatment.

However, the authors of a new case report suggest that for some Lyme carditis patients, placement of a temporary permanent pacemaker (TPPM) may be an effective and safe alternative.

In their article, “A Practical Ambulatory Approach to Atrioventricular Block Secondary to Lyme Carditis,” Aromin and colleagues describe the case of a 31-year-old man who presented with heart block during the COVID-19 pandemic.¹

The man had been suffering from multiple syncope episodes. He had a history of an embedded tick, which was followed by fever, malaise and multiple rashes consistent with an erythema migrans rash.

Utilizing a TPPM is a “safe and feasible strategy in select individuals which can minimize patient morbidity as well as hospital length of stay and overall health care costs.”

A temporary transvenous pacemaker (TTVP) was inserted via the right internal jugular vein. He was treated empirically with intravenous ceftriaxone. But on day 5, the diagnosis of Lyme carditis was confirmed with positive test results.

“On day 6, a decision was made to implant a temporary permanent pacemaker (TPPM),” the authors wrote. To reduce his exposure to COVID-19, the man was discharged home rather than being transferred to the medical ward.

Two weeks after placement of his temporary permanent pacemaker, his heart block had completely resolved and the device was removed.

The authors included pictures of his TTVP and TPPM in their article.

Authors Conclude:

“Our case demonstrates that the use of a [temporary permanent pacemaker] for AV-dissociation secondary to [Lyme carditis] is a safe and feasible strategy in select individuals which can minimize patient morbidity, as well as hospital length of stay and overall health care costs.”