Incidence of Lyme carditis and Lyme carditis as a cause of pacemaker implantation – a nationwide registry-based case control study

Abstract

Abstract Background Lyme borreliosis (LB) of the heart is called Lyme carditis (LC), which often manifests with high-grade atrioventricular block (AVB) requiring pacemaker implantation. LC is treated with antibiotics and most patients recover fully after treatment. The overall incidence of LC, and of LC as cause of pacemaker implantation has not previously been systematically studied. Methods This was a case control study based on data from Swedish national registers. The study was divided into two parts; part 1 including all patients diagnosed with AVB between 2001-2018 and part 2 including all patients who had received a pacemaker due to AVB between 2010-2018. Patients diagnosed with LB 90 days before and 180 days after the AVB diagnosis were identified among the patients and compared to matched control groups generated from the general population. Results Out of 81,063 patients with AVB, 102 were diagnosed with LB. In the control group, 27 were diagnosed with LB. The yearly incidence of LC was 0.056 per 100,000 adults and year. Out of 25,241 patients who had received a pacemaker for AVB, 31 were diagnosed with LB. In the control group, 8 were diagnosed with LB. The yearly incidence of LC as a cause of pacemaker implantation was 0.033 per 100,000 adults and year. The estimated risk for patients with LC to receive a permanent pacemaker was 59%. Conclusions LC is a rare cause of AVB. Nevertheless, more than half of LC patients receive a permanent pacemaker for a condition that is easily cured with antibiotics.