Büscher Antonius, Doldi Florian, Eckardt Lars, Müller Patrick
Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany.
Eur Heart J Case Rep. 2022 Jan 18;6(1):ytac022. doi: 10.1093/ehjcr/ytac022. eCollection 2022 Jan.
Lyme disease is the most common vector-borne disease in North America and Europe. Infection with the spirochete complex can involve cardiac tissue causing Lyme carditis (LC). Due to the infection of conductive tissue, LC typically presents with varying degrees of atrioventricular conduction block. Here, we provide the first evidence that conductive tissue of the sinus node can be involved in LC resulting in higher degree sinoatrial (SA) block with concomitant syncope.
We report the case of an otherwise healthy 31-year-old female presenting with LC manifesting with SA exit block causing asystole over 12 s with concomitant syncope. Signs of SA block completely resolved with antibiotic treatment with a third-generation cephalosporin. The patient did not require permanent pacemaker implantation and had no sinus pauses after 12 months of follow-up as confirmed via implantable loop recorder.
The possibility of LC in patients with sinus node dysfunction should be considered, as adequate antibiotic therapy can spare patients from potentially unnecessary pacemaker implantation.
莱姆病是北美和欧洲最常见的媒介传播疾病。感染螺旋体复合物可累及心脏组织，导致莱姆心肌炎（LC）。由于传导组织受到感染，LC通常表现为不同程度的房室传导阻滞。在此，我们首次提供证据表明，窦房结的传导组织可参与LC，导致更高程度的窦房（SA）阻滞并伴有晕厥。
我们报告一例31岁健康女性病例，其患有LC，表现为SA传出阻滞，导致心脏停搏超过12秒并伴有晕厥。使用第三代头孢菌素进行抗生素治疗后，SA阻滞的体征完全消失。患者无需植入永久性起搏器，经植入式环路记录仪证实，随访12个月后未出现窦性停搏。
对于窦房结功能障碍患者，应考虑LC的可能性，因为充分的抗生素治疗可使患者避免潜在的不必要的起搏器植入。
