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.
Yes, go ahead and test but realize testing misses half of all cases.
Since 3rd degree heart block can be fatal, this is a big deal. Don’t let fear of antibiotics keep you from treating these poor kids. They say 5 days of antibiotics does the trick, but these patients need follow-up. Coinfections also need to be taken into consideration as certain antibiotics will not work on all pathogens. If they have Babesia, for instance, they need anti-malarials.
There are many out there giving “natural” protocols and dissing the use of antibiotics. This study on serious heart issues is a prime example of the fact that Lyme can kill & time is of the essence.
More on heart issues with Lyme: https://madisonarealymesupportgroup.com/2018/06/03/heart-problems-tick-borne-disease/