2020 Jan 24;164. pii: D4214.

Second-degree atrioventricular block caused by Lyme disease

[Article in Dutch]



Tick-borne diseases, including Lyme disease, are becoming increasingly common in Europe. Lyme disease has a wide variety of clinical manifestations, as a result of which physicians of diverse disciplines are coming into contact with such patients.


A 58-year-old man was seen at the emergency room with a symptomatic Wenckebach-type second-degree atrioventricular (AV) block and periods of 2:1 AV block. Four weeks previously the patient had noticed a red skin lesion on his left lower leg. Under the working diagnosis of early disseminated Lyme disease with cardiac involvement, treatment with ceftriaxone was started. This diagnosis was supported by a positive Borrelia PCR and culture of a skin biopsy and positive Borreliaserology. The AV conduction disorders resolved completely after 2 weeks of treatment with antibiotics and it was not necessary to implant a pacemaker.


A Borrelia infection is a reversible but rare cause of AV conduction disorders. In the event of sudden onset of symptoms or a severe or progressive AV conduction disorder, Lyme carditis should be considered, especially if the medical history or physical examination provides clues for Lyme disease.



Due to the fact Lyme testing is so abysmal, stating that AV conduction disorders caused by Lyme is “rare,” is premature.  It may be true that reports in the literature are rare but nobody has a clue on prevalence due to underreporting & misdiagnosis. 

This patient needs extensive follow-up.  Two weeks of antibiotics is rarely sufficient.

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