Baron Shannon, Nepal Subash, Lamichhane Madhab, Roseman Hal
Cardiology, Upstate University Hospital, Syracuse, USA.
Cureus. 2022 Sep 27;14(9):e29661. doi: 10.7759/cureus.29661. eCollection 2022 Sep.
A man in his thirties presented to the emergency department with a one-day history of syncopal episodes. He was found to have complete heart block and had multiple long and symptomatic pauses in telemetry while in the hospital. The longest pause was measured at 30 seconds. He had frequent occupational exposure to ticks and was found to have positive immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies for Lyme disease. He was immediately started on IV (intravenous) ceftriaxone and isoproterenol infusion for inotropy in anticipation of recovery of atrioventricular (AV) conduction with IV antibiotics. Rapid response was called for multiple symptomatic pauses overnight, the longest one lasting 30 seconds. The patient was taken for urgent temporary transvenous pacemaker placement in the morning. AV conduction failed to improve with IV antibiotics. A permanent pacemaker was placed on day four of hospitalization as his complete heart block failed to resolve with IV antibiotics and the patient could not be weaned from temporary pacemaker support. A complete heart block is a rare manifestation of Lyme disease and warrants a high index of suspicion when a patient in an endemic area presents with this condition. A majority of patients recover with IV antibiotics, although some patients may need to be put on temporary pacemaker support in the interim. On rare occasions, a permanent pacemaker is necessary. Atrioventricular conduction may fail to improve with IV antibiotics, and these patients may need early pacemaker support with a transvenous pacemaker in addition to IV ceftriaxone followed by permanent pacemaker placement. Our patient presented with recurrent Lyme disease and had a complete heart block on presentation, which failed to improve with IV antibiotics and required temporary transvenous pacemaker support followed by permanent pacemaker placement.
一名30多岁的男子因有一天的晕厥发作史被送往急诊科。他被诊断为完全性心脏传导阻滞，住院期间在遥测中出现多次长时间且有症状的心跳停顿。最长的停顿时间为30秒。他经常在工作中接触蜱虫，并且检测发现其莱姆病免疫球蛋白G（IgG）和免疫球蛋白M（IgM）抗体呈阳性。鉴于预计静脉注射抗生素后房室传导会恢复，他立即开始接受静脉注射头孢曲松和异丙肾上腺素输注以增强心肌收缩力。当晚因多次有症状的心跳停顿呼叫了快速反应小组，最长一次持续30秒。次日上午，患者接受了紧急临时经静脉起搏器植入术。静脉注射抗生素后房室传导未能改善。由于静脉注射抗生素后他的完全性心脏传导阻滞仍未缓解，且患者无法脱离临时起搏器支持，因此在住院第四天植入了永久性起搏器。完全性心脏传导阻滞是莱姆病的一种罕见表现，当流行地区的患者出现这种情况时，需要高度怀疑。大多数患者通过静脉注射抗生素可康复，尽管有些患者在此期间可能需要临时起搏器支持。在极少数情况下，需要植入永久性起搏器。静脉注射抗生素后房室传导可能无法改善，这些患者除了静脉注射头孢曲松外，可能还需要早期经静脉起搏器支持，随后植入永久性起搏器。我们的患者表现为复发性莱姆病，就诊时存在完全性心脏传导阻滞，静脉注射抗生素后未改善，需要临时经静脉起搏器支持，随后植入永久性起搏器。
