Lyme disease increases risk of atrial fibrillation

Boy with Lyme disease and atrial fibrillation being resuscitated by EMT

Atrial fibrillation, the most common type of arrhythmia (irregular heartbeat), can increase your risk of strokes, heart disease or other heart-related complications. In many cases, atrial fibrillation is associated with a history of cardiac inflammation, writes Szymanska et al. in their article “History of Lyme Disease as a Predictor of Atrial Fibrillation.”

 

Although researchers have gained a better understanding of atrial fibrillation, also called AFib or AF, many of the causes and risk factors are still unknown. Now, for the first time, a study examines the prevalence of atrial fibrillation in Lyme disease patients.

“It is hypothesized that in some cases the AF [atrial fibrillation] might be a consequence of past low-grade myocarditis,” the authors explain. “One of the understudied, potential sources of carditis is Borrelia infection-causing Lyme disease and Lyme carditis.”

The authors looked at 113 adult patients with atrial fibrillation, who were attending a cardiac clinic in Poland between 2018 and 2019 and compared them with 109 patients with no history of AFib. The mean age of study participants was 75.8 years, with 40% male.

Atrial fibrillation patients were more likely to suffer from obesity, hypertension, chronic kidney disease, and heart failure than patients in normal sinus rhythm. AFib patients were also more likely to have left atrial enlargement.

Borrelia and the Heart

Multiple studies have shown that Borrelia bacteria can infect all parts of the heart including the conduction system, endocardium, cardiac muscle, and cardiac blood vessels, or heart valves.

“The more common location for the [Borrelia] spirochete-associated inflammation are fibers at the base of the heart, basal interventricular septum, and perivascular regions,” the authors write.

Study shows that exposure to Borrelia infection is associated with an increased risk of atrial fibrillation. Click To Tweet

Unfortunately, few intravital atrial biopsies are performed so not much is known about atrial inflammation, caused by Borrelia infections, especially in patients with atrial fibrillation.

There have been several case reports of atrial fibrillation in Lyme disease patients. But, “most reported AF as an additional finding in patients with atrioventricular blocks associated with Lyme carditis,” the authors write.

This is believed to be the first study to explore the prevalence of atrial fibrillation in Lyme disease patients.

Study Findings

“The study showed that patients with AF [atrial fibrillation] are over 8 times more likely to have positive Borrelia antibodies,” writes Szymanska.

According to the authors, 34.5% of the patients with AFib had a positive Borrelia infection compared to only 6.4% of patients in normal sinus rhythm.

They also report that “the presence of the anti-Borrelia IgG antibodies was a strong independent predictor of [atrial fibrillation] AF (odds ratio 8.21; 95% confidence interval 3.08 to 21.88; p <0.0001).

READ MORE: 12-year-old boy suffers cardiac arrest due to Lyme disease

The authors suggest two possible reasons for the higher prevalence of AFib in Lyme disease patients:

“This might indicate a history of low-grade Borrelia-associated inflammation of Lyme disease and could potentially result in atrial remodeling and AF.”

And secondly, “Borrelia burgdorferi may persist in the extracellular matrix for a long time and induce cross-reactive antibodies that react with self-components, resulting in autoimmune injury.”

The authors noted limitations of their study. They did not include a confirmatory Western Blot test due to costs and availability. Their results need to be verified. And an association is not enough to establish causation.

Authors’ Conclusion

“Certainly, larger and better-designed studies are needed to confirm the association between Lyme disease and AF, but for now, it is important for physicians treating patients in endemic areas to consider Lyme carditis as a potential cause for [atrial fibrillation] AF.”

References:
  1. Szymanska A, Platek AE, Dluzniewski M, Szymanski FM. History of Lyme Disease as a Predictor of Atrial Fibrillation. Am J Cardiol. 2020;125(11):1651-1654.


9 Replies to "Lyme disease increases risk of atrial fibrillation"

  • dave ferguson
    04/30/2022 (5:21 pm)
    Reply

    I had Lyme disease in 2008 treated with 3 months of iv rocephin. I have had afib not crontrolled well for several years. This winter had heart failure due to the afib. They tried to do electro cardoiversion which worked for a few days but returned to afib. I am on metoprolol, jardiance, lasix, xarelto and losartan. The electrocardiologiat said abblation will likely not work and rec to do a pacemaker. Want to be sure this is the right approach .

    • Dr. Daniel Cameron
      05/03/2022 (7:56 am)
      Reply

      There are so many causes of atrial fibrillation to consider. I still look for evidence of a tick borne illness.

  • Tyrone Baird
    04/15/2022 (7:31 pm)
    Reply

    During the summer of 1998 I was walking home in a pair of shorts due to hot weather, when I returned home I noticed a slight itching on the shin of my leg, I went to bed and when I awoke the next morning my leg had swelled up considerably and there was a red bullseye mark. I went to see my GP and he told me to go straight to the emergency dept. I was kept in hospital for 3 nights to treat the bite and returned home. Approx 3 years later I began having palpations which eventually was diagnosed as atrial fibrillation (lone afib). Could there be a link to the bite and the afib?

    • Dr. Daniel Cameron
      04/17/2022 (8:04 am)
      Reply

      There are so many causes of atrial fibrillation. I reported on a published case in my blog to encourage doctors to look a second time for Lyme disease.

  • Deborah Zook
    04/15/2022 (9:22 am)
    Reply

    In 2008 I was taking a shower and notice the right calf of my leg was swollen and had a big bullseye redness on it. I did not see a tick but we live in the on a mountain in PA and often get tick bites. I went to the doctor who said she thought it was a tick bite and gave me 3 antibiotics pills to take. Since then I have large knees that are painful and hot and I am very tried a lot. My hands are sore mostly my thumbs. I see floating color spots and my eye site blurry. I did get checked about 5 years after the bite again for limes and it came back all but one marker was positive for limes so I was told o do not have limes disease. I now have AFib. And I often wonder did they miss diagnose me?

    • Dr. Daniel Cameron
      04/15/2022 (10:01 am)
      Reply

      I have not found the laboratory tests all that reliable. I have had to treat some of my patients based on clinical judgement rather than relying solely on the test. I have always encouraged someone who has bee ill for years after a tick and rash to be reevaluated by a doctor experienced in treating Lyme disease. BTW I would not be comfortable with “3” doxycycline after a tick bite.

  • Paula Johnston
    11/22/2021 (5:51 pm)
    Reply

    Are there Lyme cardiologists in the US…or at least cardiologists who understand Lyme Disease and the devastation it causes in the body?

    • Dr. Daniel Cameron
      11/23/2021 (7:11 am)
      Reply

      I use cardiologist primarily to be sure I have not overlooked another illness.

  • Wallingford
    02/11/2021 (12:02 am)
    Reply

    I was diagnosed with A Fib in 2017 after a bad reaction to Targretin and Levothyroxine, taken for NHL.
    Only God knows if the Bb and Babesia, acquired in 1995, contributed to the pathology.


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