ro13-9904 and Atrial-Fibrillation

Topics: Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Aortic Valve Stenosis; Atrial Fibrillation; Autoantibodies; Autoimmune Diseases; Ceftriaxone; Combined Modality Therapy; Emergencies; Factor V; Factor V Deficiency; Female; Heart Failure; Humans; Partial Thromboplastin Time; Platelet Transfusion; Prednisone; Preoperative Care; Prothrombin Time; Pyrazoles; Pyridones; Transcatheter Aortic Valve Replacement; Urinary Tract Infections

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.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Atrial Fibrillation; Atrioventricular Block; Blotting, Western; Ceftriaxone; Electrocardiography; Humans; Lyme Disease; Male; Middle Aged; Myocarditis; Rare Diseases; Syncope; Treatment Outcome

We present a case of a 23-year-old man coming with palpitations, found to be in atrial fibrillation (AF). He was initially managed with metoprolol for rate-controlled therapy-reverted to normal sinus rhythm and discharged home. He returned a few days later-this time in varying degrees of atrioventricular block including transient complete heart block. He was empirically started on intravenous ceftriaxone for suspected Lyme carditis, which subsequently led to the resolution of high-degree heart block. Lyme immunoglobulin G (IgG) and IgM returned positive. Follow-up ECG after the course of antibiotic exhibited normal sinus rhythm. AF is a rare presentation of Lyme disease but still exists. It should be considered in terms of appropriate treatment, especially in Lyme-endemic areas.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Atrial Fibrillation; Atrioventricular Block; Ceftriaxone; Diagnosis, Differential; Electrocardiography; Humans; Lyme Disease; Male; Treatment Outcome; Young Adult

Topics: Anti-Bacterial Agents; Anticoagulants; Arteriovenous Fistula; Atrial Fibrillation; Bacteremia; Ceftriaxone; Combined Modality Therapy; Coronary Disease; Coronary Sinus; Coronary Vessel Anomalies; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Ligation; Male; Middle Aged; Mitral Valve; Pulmonary Embolism; Streptococcal Infections; Streptococcus mitis; Tricuspid Valve; Ultrasonography

Topics: Anti-Infective Agents; Atrial Fibrillation; Ceftriaxone; Cell Transformation, Neoplastic; Coronary Artery Disease; Diagnosis, Differential; Humans; Hyperlipidemias; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma; Male; Middle Aged; Neoplasm Recurrence, Local; Nocardia Infections; Seizures; Smoking; Trimethoprim, Sulfamethoxazole Drug Combination