Temporary Pacemaker for Lyme Carditis Heart Block
Lyme carditis can cause serious heart block
Some patients may require temporary pacing support
Heart rhythm abnormalities may improve with antibiotics
Lyme carditis can lead to atrioventricular (AV) block severe enough to require temporary pacing support.
Fortunately, many conduction abnormalities caused by Lyme disease improve after appropriate antibiotic treatment, allowing patients to avoid permanent pacemaker implantation.
A recent case report highlighted the use of a temporary permanent pacemaker (TPPM) as a bridge while Lyme carditis-related heart block resolved.¹
Case Report: Temporary Pacemaker for Lyme Carditis
Aromin and colleagues described the case of a 31-year-old man who presented during the COVID-19 pandemic with recurrent syncope episodes and high-grade AV block.¹
The patient had a history of an embedded tick followed by fever, malaise, and multiple rashes consistent with erythema migrans.
Because of worsening conduction abnormalities, a temporary transvenous pacemaker (TTVP) was initially inserted through the right internal jugular vein while the patient received empiric intravenous ceftriaxone.¹
On hospital day 5, Lyme carditis was confirmed with positive Lyme disease testing.¹
Why a Temporary Permanent Pacemaker Was Used
On day 6, clinicians transitioned the patient from a temporary transvenous pacemaker to a temporary permanent pacemaker (TPPM).¹
The authors proposed that a TPPM may provide a safer and more practical ambulatory option for selected Lyme carditis patients who require longer pacing support.
Using a TPPM allowed the patient to leave the hospital during the COVID-19 pandemic rather than remain hospitalized for prolonged monitoring.
Two weeks later, the patient’s heart block completely resolved and the pacemaker was removed.¹
Lyme Carditis Can Mimic Other Cardiac Emergencies
Lyme carditis may present with:
- Syncope or near-syncope
- Dizziness
- Chest discomfort
- Palpitations
- Shortness of breath
- High-grade AV block
In endemic regions, clinicians should consider Lyme disease in younger patients presenting with unexplained conduction abnormalities.
Learn more about Lyme carditis symptoms and diagnosis.
Temporary Versus Permanent Pacemakers
Most Lyme carditis patients recover normal cardiac conduction after antibiotic treatment.
Because AV block is often reversible, clinicians may attempt temporary pacing support before considering permanent pacemaker implantation.
The case report suggests that temporary permanent pacemakers may reduce:
- Hospital length of stay
- Patient morbidity
- Exposure risks during hospitalization
- Unnecessary permanent pacemaker placement
This approach may not be appropriate for every patient and requires individualized cardiology assessment.
Why Early Recognition Matters
Delayed recognition of Lyme carditis can increase the risk of severe conduction disturbances and complications.
Patients may not always recall a tick bite or notice a classic erythema migrans rash.
Prompt recognition and antibiotic treatment may improve outcomes and reduce the likelihood of invasive cardiac procedures.
Learn more about delayed Lyme disease diagnosis.
Frequently Asked Questions
Can Lyme disease cause heart block?
Yes. Lyme carditis can interfere with electrical conduction in the heart and cause AV block.
Do Lyme carditis patients always need a permanent pacemaker?
No. Many patients improve with antibiotics and temporary pacing support alone.
What is a temporary permanent pacemaker?
A temporary permanent pacemaker (TPPM) uses an actively fixed pacing lead connected to an external generator to provide longer-term temporary pacing support.
Can Lyme carditis resolve completely?
Yes. Many patients recover normal cardiac conduction after appropriate antibiotic treatment.
What symptoms can Lyme carditis cause?
Symptoms may include dizziness, fainting, chest discomfort, palpitations, fatigue, or shortness of breath.
Clinical Takeaway
Lyme carditis can cause reversible heart block severe enough to require temporary pacing support.
This case highlights how temporary permanent pacemakers may help selected patients avoid prolonged hospitalization and unnecessary permanent pacemaker implantation while antibiotic treatment reverses conduction abnormalities.
Early recognition of Lyme carditis remains critical because prompt treatment may reverse heart block and improve outcomes.
Related Articles
These related articles explore Lyme carditis diagnosis, conduction abnormalities, and complications associated with delayed recognition.
Lyme disease symptoms guide
Pacemaker for Lyme carditis
How common is Lyme carditis in patients referred for pacemaker implantation?
Lyme disease misdiagnosis
Post-treatment Lyme disease syndrome (PTLDS)
References
- Aromin C, Chanda A, Kumar S, Thomas GR. A Practical Ambulatory Approach to Atrioventricular Block Secondary to Lyme Carditis. J Innov Card Rhythm Manag. 2023;14(3):5365-5368.
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
