Lyme Disease Triggers Ventricular Tachycardia and Third-Degree Heart Block in Teen
A 15-year-old boy developed ventricular tachycardia and complete heart block from Lyme disease.
His heart rate reached 300 beats per minute.
IV antibiotics and temporary pacing reversed the condition.
Medics found the boy to be pale, with a heart rate of 300 beats per minute and unstable regular wide complex tachyarrhythmia (WCT). He was given a dose of amiodarone but remained in ventricular tachycardia.
At the hospital his blood pressure dropped to 66/30 mm Hg and his dizziness and shortness of breath worsened. “After a trial of anti-arrhythmic medication, his clinical condition declined, necessitating synchronized cardioversion,” writes Nawrocki.
After stabilizing the patient, he was transferred to a cardiac intensive care unit (ICU) at a children’s hospital, where he was diagnosed with third-degree heart block after ventricular tachycardia.
Doctors suspected Lyme disease and prescribed an empiric course of intravenous ceftriaxone 2 grams once daily. The diagnosis was confirmed by the Western blot.
Third-degree heart block occurs when electrical signals between the upper and lower chambers of the heart are completely disrupted. Lyme carditis can interfere with the heart’s conduction system, leading to bradycardia, hypotension, AV block, and in rare cases dangerous ventricular arrhythmias.
Although Lyme carditis is more commonly associated with bradycardia and AV block, some patients can initially present with dangerous fast heart rhythms including ventricular tachycardia and rapid heart rates.
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“Because of ongoing bradycardia and hypotension, he underwent placement of a transvenous pacemaker for rate control,” writes Nawrocki.
Three additional episodes of ventricular tachycardia occurred, two requiring cardioversion.
But after several days of intravenous antibiotics, the boy’s heart block gradually resolved and the pacemaker was removed.
He was discharged on day 12 and “was reportedly doing well at the 1-year follow-up without any sequelae of his acute illness,” writes Nawrocki.
“Our case report describes the successful and appropriate hospital management of a patient with advanced Lyme disease causing cardiac conduction abnormalities,” the authors write.
Why This Lyme Carditis Case Matters
This case highlights how Lyme carditis can initially present with dangerous rhythm disturbances rather than a classic rash or flu-like illness. The patient developed both ventricular tachycardia and third-degree heart block — a rare but serious complication of Lyme disease.
Importantly, this teenager improved after intravenous ceftriaxone and temporary pacing support, underscoring that some severe conduction abnormalities caused by Lyme disease can be reversible when recognized early.
Patients with Lyme carditis may present with dizziness, fainting, palpitations, chest discomfort, shortness of breath, bradycardia, or abnormal fast heart rhythms. Early recognition remains important because these cardiac complications can progress rapidly.
For more on cardiac complications, see our articles on Lyme carditis and cardiac symptoms of Lyme disease.
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Reference
- Nawrocki PS, Poremba M. A 15-Year-Old Male With Wide Complex Tachyarrhythmia. Air Med J. 2018;37(6):383-387.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
