Pacemakers for Lyme carditis

Some patients with Lyme carditis (LC) require implantation of a pacemaker. Yeung and Baranchuk discussed the need for “preventing unnecessary implantation of permanent pacemakers in otherwise healthy young individuals” in the Journal of the American College of Cardiology in 2019.

Lyme disease can directly infiltrate the heart leading to an exaggerated inflammatory response when spirochetes penetrate the heart. Lyme carditis can appear within 1 to 2 months after the onset of a Lyme disease infection, wrote Yeung and Baranchuk.¹ They point out, the most common presentation of LC (90%) is high-degree atrioventricular (AV) block (AVB).

AV block due to Lyme disease can be successfully treated with antibiotics in a hospital setting. However, in some cases, a temporary or permanent pacemaker is required. In reviewing the literature, Besant and colleagues found that 17.9% of patients with LC required a permanent pacemaker and 10.3% required a temporary and a permanent pacemaker.²

“High-degree atrioventricular block is the most common presentation of [Lyme carditis], and usually resolves with antibiotic therapy.”¹

Yeung et al. highlighted the importance of avoiding a permanent pacemaker “to prevent the inherent risks of pacemaker implantation, including periprocedural infections and complications, lead dislodgement, etc.”

Furthermore, the authors emphasized the importance in avoiding a permanent pacemaker in children. “An unnecessary pacemaker implantation would result in a subsequent lifetime of multiple pulse generator changes, psychological/physical sequelae, and burden of associated cumulative health care costs.”

They concluded, “A systematic approach to the diagnosis and treatment of LC will facilitate the identification of LC in patients with high-degree AVB, thus preventing unnecessary implantation of permanent pacemakers.”

Both a standard transvenous temporary pacemaker lead, or modified temporary–permanent transvenous pacing are available.

“In modified temporary– permanent transvenous pacing, an active fixation lead is attached to a resterilized permanent pace- maker generator taped to the patient’s skin and used as a temporary external device, which allows for early ambulation,” wrote Yeung and Baranchuk.

A permanent pacemaker has been recommended if AV conduction is not restored.