Advanced Heart Block in Children with Lyme Disease
The clinical course of children with advanced heart block secondary to Lyme disease has not been well characterized.
To review the presentation, management, and time to resolution of heart block due to Lyme disease in previously healthy children.
An IRB approved single-center retrospective study was conducted of all patients < 21 years old with confirmed Lyme disease and advanced second or third degree heart block between 2007 and 2017.
Twelve patients (100% male) with a mean age of 15.9 years (range 13.2–18.1) were identified. Six patients (50%) had mild to moderate atrioventricular valve regurgitation and all had normal biventricular function. Five patients had advanced second degree heart block and 7 had complete heart block with an escape rate of 20–57 bpm. Isoproterenol was used in 4 patients for 3–4 days and one patient required transvenous pacing for 2 days. Patients were treated with 21 days (n = 6, 50%) or 28 days (n = 6, 50%) of antibiotics. Three patients received steroids for 3–4 days. Advanced heart block resolved in all patients within 2–5 days, and all had a normal PR interval within 3 days to 16 months from hospital discharge.
Symptomatic children who present with new high-grade heart block from an endemic area should be tested for Lyme disease. Antibiotic therapy provides quick and complete resolution of advanced heart block within 5 days, while steroids did not appear to shorten the time course in this case series. Importantly, no patients required a permanent pacemaker.
KeywordsLyme disease Advanced atrioventricular block Complete heart block Lyme carditis Pediatrics
There was no funding for this study.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board at Columbia University Medical Center and the need for informed consent was waived as formal informed consent was not required for this retrospective study.
- 2.Center for Disease Control and Prevention. Lyme disease (Borrelia burgdorferi) 2017 case definition. https://wwwn.cdc.gov/nndss/conditions/lyme-disease/case-definition/2017/. Accessed 7 Mar 2018
- 8.Ciardulli A, D’Antonio F, Magro-Malosso ER, Manzoli L, Anisman P, Saccone G, Berghella V. Maternal steroid therapy for fetuses with second-degree immune-mediated congenital atrioventricular block: a systematic review and meta-analysis (2018). Acta Obstet Gynecol Scand. 97(7):787–794. https://doi.org/10.1111/aogs.13338. [Epub ahead of print]
- 9.Berg Van den N, Slieker MG, van Beynum IM et al. Fluorinated steroids do not improve outcome of isolated atrioventricular block (2016). Int J Cardiol. 225:167–171. https://doi.org/10.1016/j.ijcard.2016.09.119
- 11.Umapathy S, Saxena A. Acute rheumatic fever presenting as complete heart block: report of an adolescent case and review of literature (2018). BMJ Case Rep. https://doi.org/10.1136/bcr-2017-223792