Messner Christopher R, Amara Richard S
Department of Medicine, University of Maryland, Baltimore, MD, USA.
Department of Cardiology, University of Maryland, Baltimore, MD, USA.
Eur Heart J Case Rep. 2023 Nov 24;7(12):ytad576. doi: 10.1093/ehjcr/ytad576. eCollection 2023 Dec.
Lyme carditis (LC) complete heart block (CHB) is typically treated with i.v. antibiotics without requiring permanent pacing. In patients with high degree atrioventricular (AV) block, suspicious index in Lyme carditis (SILC) scoring is highly sensitive for diagnosing LC.
We present a case of CHB where a permanent pacemaker (PPM) was implanted prior to LC diagnosis. Suspicious index in Lyme carditis score was 2 at the time of exam, indicating a low risk for LC. However, per further discussion at follow-up, his score was retroactively increased to an intermediate risk of 4 and Lyme titres returned positive. An outpatient oral antibiotic regimen was given, and 2 months later, the patient had <0.1% V-pacing on interrogation with a subsequent unremarkable event monitor. The pacemaker was removed after considerations ensuring full conduction recovery. The patient is doing well at follow-up > 1 year.
Lyme carditis spontaneous resolution of CHB is common. Once safe extraction parameters have been established, it is appropriate to engage patients without ongoing pacer requirements about explantation of their PPM. For CHB patients without clear aetiology, SILC scoring may be a predictive measure to help prevent unnecessary PPM placement in the future.
莱姆病性心肌炎（LC）导致的完全性心脏传导阻滞（CHB）通常采用静脉注射抗生素治疗，无需植入永久性起搏器。在高度房室传导阻滞患者中，莱姆病性心肌炎可疑指数（SILC）评分对诊断LC具有高度敏感性。
我们报告一例CHB患者，在诊断LC之前植入了永久性起搏器（PPM）。检查时莱姆病性心肌炎评分的可疑指数为2，表明LC风险较低。然而，经后续进一步讨论，其评分追溯性提高至中度风险4，莱姆病滴度呈阳性。给予门诊口服抗生素治疗方案，2个月后，患者在起搏器程控时心室起搏率<0.1%，随后事件监测无异常。在确保完全恢复传导后，考虑移除起搏器。随访1年以上，患者情况良好。
莱姆病性心肌炎导致的CHB自发缓解很常见。一旦确定了安全的拔除参数，对于不再需要起搏器的患者，进行PPM拔除是合适的。对于病因不明的CHB患者，SILC评分可能是一种预测措施，有助于预防未来不必要的PPM植入。
Zotero 插件
