How to Better Identify Lyme Carditis So Pacemakers Aren’t Unnecessarily Given to Patients

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Suspicious index in Lyme carditis: Systematic review and proposed new risk score

Abstract

BACKGROUND:

Lyme carditis (LC), an early manifestation of Lyme disease that most commonly presents as high-degree atrioventricular block (AVB), usually resolves with antibiotic treatment. When LC is not identified as the cause of AVB, a permanent pacemaker may be inappropriately implanted in a reversible cardiac conduction disorder.

HYPOTHESIS:

The likelihood that a patient’s high-degree AVB is caused by LC can be evaluated by clinical characteristics incorporated into a risk stratification tool.

METHODS:

A systematic review of all published cases of LC with high-degree AVB, and five cases from the authors’ experience, was conducted. The results informed the development of a new risk stratification tool, the Suspicious Index in LC (SILC) score. The SILC score was then applied to each case included in the review.

RESULTS:

Of the 88 cases included, 51 (58%) were high-risk, 31 (35.2%) intermediate-risk, and 6 (6.8%) low-risk for LC according to the SILC score (sensitivity 93.2%). For the subset of 32 cases that risk, and 0 low-risk (sensitivity 100%). Specificity could not be assessed (no control group). Notably, 6 of the 11 patients who received permanent pacemakers had reversal of AVB with antibiotic treatment.

CONCLUSION:

The SILC risk score and COSTAR mnemonic (constitutional symptoms; outdoor activity; sex = male; tick bite; age < 50; rash = erythema migrans) may help to identify LC in patients presenting with high-degree AVB, and ultimately, minimize the implantation of unnecessary permanent pacemakers.

Source:  By Besant G1, Wan D1, Yeung C1, Blakely C1, Branscombe P1, Suarez-Fuster L1, Redfearn D1, Simpson C1, Abdollah H1, Glover B1, Baranchuk A1. Suspicious index in Lyme carditis: Systematic review and proposed new risk score. Clin Cardiol. 2018 Oct 23. doi: 10.1002/clc.23102. [Epub ahead of print]

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