Hammarlund Peter, Ljungström Erik, Bremell Daniel
Specialistläkare, kardiologsektionen, Helsingborgs lasarett.
överläkare, överläkare, arytmisektionen, hjärt- och lungkliniken, Skånes universitetssjukhus Lund.
Lakartidningen. 2024 Apr 9;121:23171.
In elderly patients high-degree atrioventricular (AV) block is often due to irreversible degeneration of the cardiac conduction system. Reversible causes must however be excluded prior to pacemaker implantation. In younger patients reversible causes are more likely, as well as more unusual etiologies. Lyme carditis is a rare, but reversible cause of AV block. It is a manifestation of Lyme borreliosis - an infectious disease caused by the bacteria Borrelia burgdorferi. Lyme carditis should particularly be considered in young and middle-aged patients with a high-degree AV block. When pretest probability is intermediate to high, a positive serological test makes the diagnosis of Lyme carditis highly likely. In these cases antibiotic treatment may revert the conduction disturbance, thus preventing unnecessary implantation of a permanent pacemaker.
在老年患者中，高度房室传导阻滞通常是由于心脏传导系统的不可逆性退变所致。然而，在植入起搏器之前必须排除可逆性病因。在年轻患者中，可逆性病因更为常见，同时也存在更多不寻常的病因。莱姆心肌炎是一种罕见但可逆的房室传导阻滞病因。它是莱姆病的一种表现，莱姆病是由伯氏疏螺旋体细菌引起的一种传染病。对于患有高度房室传导阻滞的中青年患者，尤其应考虑莱姆心肌炎。当检测前概率为中度至高时，血清学检测呈阳性很可能诊断为莱姆心肌炎。在这些情况下，抗生素治疗可能会逆转传导障碍，从而避免不必要地植入永久性起搏器。
