The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 05; 11(1):e1-e1 

Intermittent High Grade AV-Block and 
Atrial Flutter Associated with Lyme 
Carditis: A Case Report 
Ahmad Abdelrahman, MD1*, Abdulmajeed Alharbi, MD1, Zeid Nesheiwat, DO, 
MPH1, Robert Grande, MD 

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: ahmad.abdelrahman@utoledo.edu

Published: 05 May 2023 

Introduction:  Lyme disease is the most common tick-borne infection caused by spirochetes in the 
Borreliacidal family. In USA, infection is caused primary by Borrelia burgdorferi. Lyme disease 
typically progresses in phases. The clinical manifestations progress from early localized to early 
disseminated disease and then finally late disease. Lyme carditis occurs in 1% of untreated patients in 
the early disseminated phase. While complete AV-block is most common, atrial flutter is a rarer 
manifestation. 

Case Report:  Otherwise healthy 43-year-old man presented with new onset dizziness, fatigue, and 
syncope. Initial EKG showed complete heart block. Telemetry showed he developed underlying atrial 
flutter with episodes of ventricular standstill. Echocardiogram and cardiac MRI were unremarkable. 
Troponin was negative. Serologies for borrelia burgdorferi as well Lyme IgG and IgM western blot were 
positive. He was treated with IV Ceftriaxone and discharged with an active fixation pacemaker. 

Discussion:  Cardiac involvement occurs during the early disseminated phase of the disease usually 
within weeks after the onset of infection. 90% of Lyme carditis presents as high-degree atrioventricular 
block (AVB), whereas the other 10% is represented by myocarditis, pancarditis or other types of 
arrhythmias and conduction disorders. Other abnormalities that may occur include prolonged QTc, 
asystolic pauses and other supraventricular tachyarrhythmias. The mechanism of atrial flutter in Lyme 
carditis isn’t fully understood. 

Conclusion: It is important for physicians to understand the cardiac manifestations of Lyme disease. 
Patients who are otherwise young and healthy, who present acutely in an otherwise unexplained cardiac 
rhythm should have Lyme carditis ruled out or at least considered. 

https://dx.doi.org/10.46570/utjms.vol11-2023-634 

https://dx.doi.org/10.46570/utjms.vol11-2023-634
mailto:ahmad.abdelrahman@utoledo.edu