Pacemakers for Lyme Carditis

Pacemakers for Lyme carditis may be required when Lyme disease causes severe disturbances in the heart’s electrical conduction system. Lyme carditis occurs when Borrelia burgdorferi spirochetes infiltrate heart tissue and trigger inflammation that disrupts normal cardiac conduction.

Lyme carditis typically develops within 1 to 2 months after the onset of Lyme disease infection, according to Yeung and Baranchuk. The most common presentation is high-degree atrioventricular block (AV block), which occurs in approximately 90% of Lyme carditis cases.

When Pacemakers Are Needed for Lyme Carditis

AV block caused by Lyme disease is often reversible with antibiotics and careful monitoring in a hospital setting. However, some patients develop severe conduction abnormalities requiring pacing support.

In a review of the literature, Besant and colleagues reported that:

• 17.9% of Lyme carditis patients required a permanent pacemaker
• 10.3% required both temporary and permanent pacing

“High-degree atrioventricular block is the most common presentation of Lyme carditis and usually resolves with antibiotic therapy.”

Avoiding Unnecessary Permanent Pacemakers

Because Lyme carditis often improves with antibiotic therapy, clinicians are encouraged to avoid permanent pacemaker implantation whenever possible.

Permanent pacemakers carry risks including infection, lead dislodgement, and procedural complications. In addition, patients may require multiple generator replacements over their lifetime.

This issue is especially important in children. Yeung and Baranchuk emphasize that unnecessary pacemaker placement in pediatric patients can lead to decades of device replacements, medical costs, and potential psychological and physical complications.

Temporary Pacing Options for Lyme Carditis

Several temporary pacing strategies may be used while the infection is treated.

One option is a standard temporary transvenous pacemaker lead. Another approach is modified temporary-permanent transvenous pacing.

In this technique, an active fixation pacing lead is connected to a resterilized permanent pacemaker generator taped to the patient’s skin and used as an external device. This method allows greater patient mobility and early ambulation.

When Permanent Pacemakers Are Considered

A permanent pacemaker may be recommended if AV conduction fails to recover despite appropriate antibiotic therapy.

However, because Lyme carditis is frequently reversible, clinicians often monitor patients carefully before making this decision.

Early recognition and treatment of Lyme carditis can prevent progression to severe conduction abnormalities and reduce the need for permanent pacemakers.

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