Successful removal of pacemakers in patients with Lyme carditis

In their study “Pacemaker Explantation in Patients With Lyme Carditis,” Wamboldt and colleagues¹ describe two cases involving the removal of pacemakers in patients with Lyme carditis, which highlights the importance of including Lyme carditis in the differential diagnosis for high-degree AV block.

Furthermore, these cases demonstrate the “benefits of early device interrogation in patients who have been treated for Lyme carditis and received a pacemaker during their treatment,” the authors explain.

Lyme carditis can lead to cardiac arrhythmias and conduction disorders, most commonly atrioventricular (AV) blocks.

Case #1

“A 48-year-old woman presented with shortness of breath and dizziness secondary to complete heart block,” the authors write. “Given the presence of symptomatic bradycardia, she was transferred to a tertiary hospital for pacemaker implantation.”

She had a non-specific rash on her abdomen 3 months before symptom onset.

Lyme disease testing was positive.

Authors’ Takeaway: “Pacemaker explantation is a potential option for patients with treated [Lyme carditis] who have undergone proper testing to ensure that normal cardiac conduction has resumed.”

Case #2

A 58-year-old man presented with dizziness, syncope, headache and myalgia. “His initial electrocardiogram showed atrial fibrillation with slow ventricular response,” the authors write. “During his admission he experienced symptomatic pauses lasting 4 to 10 seconds.”

He also had a pacemaker implantation.

Lyme disease testing was positive.

Both patients were treated successfully with antibiotics.

Typically, Lyme disease patients with conduction problems are placed on a temporary pacemaker. In both of these cases, the patients were placed on a permanent pacemaker.

On follow-up, both pacemakers were functioning. “Both patients underwent exercise stress testing and were able to maintain 1:1 conduction at a heart rate >120 beats/min,” according to the authors.

The permanent pacemakers were removed successfully.

“Within the first year of insertion, transvenous lead extraction has a high success rate and a low complication rate,” the authors explain. The pacemaker is more difficult to remove if present over a year due to fibrotic changes.

“This highlights the importance of close follow-up so that early pacemaker explantation can be arranged if clinically indicated,” the authors suggest.