Lyme carditis presenting as atrial fibrillation
The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.
A better statistic would be that in 2017, the CDC estimated the number of NEW cases of Lyme disease to be approximately 430,000 – which is 6 times the prevalence of HIV/AIDS and nearly twice as prevalent as breast cancer. The numbers have only increased since that time.
As to cardiac involvement only occurring in 1% of untreated patients & atrial fibrillation with rapid ventricular response being rare, I highly doubt it. Testing misses over half of all cases with research ignoring chronically infected patients since inception and nobody’s keeping score because cases aren’t being diagnosed, treated, researched, and recorded.
Heart involvement with Lyme is not new: https://madisonarealymesupportgroup.com/2019/03/10/when-lyme-hurts-your-heart-warning-signs-solutions/