Study Identifies 189 Children With Lyme Carditis

Heart complications from Lyme disease extend far beyond classic heart block. A national study identified 189 children with Lyme carditis showing a broad spectrum of cardiac problems — from myocarditis to cardiac arrest — with median treatment costs exceeding $9,000 per child.

The Growing Burden of Cardiac Lyme Disease in Children

Lyme disease can affect multiple organs, including the heart. When the infection involves cardiac tissue, the condition is known as Lyme carditis. Lyme carditis occurs when the Lyme disease bacterium Borrelia burgdorferi affects the heart’s electrical conduction system or heart muscle.

This can lead to heart block, myocarditis, or abnormal heart rhythms. Heart symptoms from Lyme disease may include chest pain, palpitations, fainting, shortness of breath, or unexplained fatigue.

In their article addressing the heart and Lyme disease connection, Beach and colleagues reported a rising number of Lyme carditis cases in U.S. children’s hospitals. The largest increases were observed in the Midwest, including the Ohio Valley.

The researchers analyzed a national hospital database to identify pediatric Lyme carditis cases and better characterize the spectrum of cardiac complications in children with Lyme disease.

Who Gets Cardiac Lyme Disease?

The children diagnosed with Lyme carditis were generally older than children with Lyme disease who did not have cardiac involvement. The average age was approximately 13 years, and boys were more frequently affected.

This pattern mirrors what is seen in adults, where young males are disproportionately affected by Lyme carditis. Increased outdoor exposure during sports, hiking, and camping may contribute to this trend.

The Financial Burden of Pediatric Lyme Carditis

“Encounters for Lyme carditis are dramatically costlier than those for Lyme disease without carditis,” the authors report.

The economic impact was substantial:

• Median cost with Lyme carditis: $9,104 (range $3,741–$19,003)
• Median cost without carditis: $922 (range $238–$4,987)

Hospitalization for Lyme carditis cost roughly ten times more than treatment for Lyme disease without cardiac involvement.

These costs reflect hospitalization, cardiac monitoring, IV antibiotic therapy, cardiology consultation, and in some cases temporary pacing.

However, direct medical costs capture only part of the burden. Missed school, parental work absence, emotional distress, and concerns about long-term heart health also affect families.

Outcomes in Children

None of the 189 children identified in the database died during hospitalization. However, the database did not include out-of-hospital outcomes.

This limitation is important. Although pediatric Lyme carditis deaths are rare, fatal cases have been documented when diagnosis or treatment is delayed.

Broad Spectrum of Cardiac Findings

The study revealed a wide range of cardiac diagnoses among the 189 children. These findings suggest the cardiac manifestations of Lyme disease extend beyond the classic heart block presentation.

The cardiac diagnoses included:

• First-degree AV block – 28%
• Acute myocarditis – 27%
• Complete AV block – 17%
• Second-degree AV block – 15%
• Heart disease NOS – 9%
• Non-specific ECG abnormality – 4%
• Cardiomyopathy – 4%
• Premature beats – 3%
• Right bundle branch block – 3%
• Acute pericarditis – 2%
• Atrial fibrillation/flutter – 2%
• Paroxysmal ventricular tachycardia – 2%
• Cardiac arrest – 2%
• Congestive heart failure – 2%
• Other cardiac dysrhythmias – 38%

What This Data Suggests

Several patterns emerge from these findings.

AV block is common but not universal. While AV block accounted for many cases, approximately 40% of children had other cardiac manifestations.

Myocarditis was surprisingly frequent. Inflammation of the heart muscle occurred nearly as often as first-degree AV block.

Serious arrhythmias can occur. Ventricular tachycardia, cardiac arrest, and heart failure were documented in a small percentage of cases.

Geographic Expansion

The study found the largest increases in Lyme carditis cases in the Midwest, including the Ohio Valley.

This expansion reflects the growing spread of tick populations carrying Borrelia burgdorferi across North America.

Clinicians outside historically endemic areas should consider Lyme disease when evaluating children with unexplained cardiac abnormalities.

Clinical Perspective

The breadth of cardiac complications documented in this study highlights the importance of recognizing early heart symptoms of Lyme disease in children.

While heart block remains the best known complication, myocarditis, pericarditis, and arrhythmias may also occur.

Fortunately, most children recover fully when Lyme carditis is recognized early and treated promptly with antibiotics.

Frequently Asked Questions

Can children develop heart problems from Lyme disease?

Yes. Lyme disease can affect the heart and cause Lyme carditis. In this study, 189 children were identified with cardiac complications including heart block, myocarditis, and arrhythmias.

What are the most common heart problems in pediatric Lyme disease?

First-degree AV block (28%) and myocarditis (27%) were the most common cardiac findings in this study.

Can Lyme disease affect the heart?

Yes. Lyme disease can affect the heart and cause Lyme carditis. The infection may disrupt the heart’s electrical system, leading to heart block, myocarditis, or abnormal heart rhythms.

How much does Lyme carditis treatment cost?

The median hospital cost was $9,104 per child, approximately ten times higher than treatment for Lyme disease without cardiac involvement.

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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