AV tam blok nedeni olan Lyme hastalığında EKG bulguları gözden kaçıyor mu?

Year 2024, , 1 - 9, 30.04.2024

Osman Bektaş , Fatih Akkaya

https://doi.org/10.56941/odutip.1371403

Abstract

Amaç: Lyme hastalığına bağlı kardit ve ileti bozuklukları iyi bilinmektedir ancak Lyme hastalığının global elektrokardiyografi (EKG) morfolojisi üzerine etkileri konusunda literatürde yeterli veri bulunmamaktadır. Bu çalışma Lyme hastalığının EKG morfolojisi üzerindeki etkilerini değerlendirmeyi amaçlamaktadır.
Yöntem: Çalışmaya 01 Ocak 2020 ile 01 Ağustos 2023 tarihleri arasında AV tam blok tanısıyla merkezimizde yatan 48 ardışık hasta dahil edildi. Hastalar Lyme pozitif (Grup 1) ve negatif (Grup 2) olmak üzere iki gruba ayrıldı. Daha sonra hastaların demografik ve laboratuvar verileri kaydedildi. Ventriküler hız, atriyal hız, QRS süresi, P dalga dispersiyonu (Pd), QTc dispersiyonu (QTcd) ve fragmente QRS dahil tüm EKG verileri, 25 mm/s ve 10 mm/s hızlarında standart ekstremite ve göğüs derivasyonları kullanılarak elde edilen rutin elektrokardiyogramlardan analiz edildi. Elde edilen veriler gruplar arasında karşılaştırıldı.
Bulgular: Grup 1'de yaş ortalaması sırasıyla 72,5(51,7-82,2), grup 2'de 74(68-79,7) idi. Aralarında anlamlı bir fark yoktu (P= 0.593). Çalışma popülasyonunda gruplar arasında erkek ve kadın oranı benzerdi. Çalışma grubunun EKG değerlendirmesinde atriyal hız, ventriküler hız, QRS süresi, QTc süresi ve fragmante QRS sıklığı arasında anlamlı fark saptanmadı (p<0,05). QTcd ve Pd Lyme+'da (Grup 1) anlamlı derecede yüksekti. (sırasıyla 75(56-84,5) vs 52(45-64,5), p=0,002; 58(50-62) vs 42,5(39-45,5), p<0,001).
Sonuç: Çalışmamızın sonuçları değerlendirildiğinde; Lyme hastalığı, literatürde bilindiği gibi AV düğümünü etkilemeye ek olarak, Pd ve QTcd'de artışa neden olmaktadır. Bu bulgular Lyme hastalığının kardiyak tutulumununda, kardiyak ileti sistemini sanıldığından daha fazla etkilediğini düşündürmektedir.

Keywords

Lyme hastalığı, Elektrokardiyografi, AV tam blok

Project Number

2023/36

Are ECG findings overlooked in Lyme disease, which is the cause of AV complete block?

Abstract

Objective: Lyme disease-associated carditis and conduction disturbances are well known, but there is insufficient data in the literature on the effects of Lyme disease on global electrocardiography (ECG) morphology. This study aims to evaluate the effects of Lyme disease on ECG morphology.
Method: The study included 48 consecutive patients who were hospitalised in our centre with a diagnosis of AV complete block between 01 January 2020 and 01 August 2023. Patients were divided into two groups as Lyme positive (Group 1) and negative (Group 2). Afterwards, demographic and laboratory data of the patients were recorded. All ECG data including ventricular rate, atrial rate, QRS duration, P wave dispersion (Pd), QTc dispersion (QTcd), and fragmented QRS were analysed from routine electrocardiograms obtained using standard extremity and chest leads at 25 mm/s and 10 mm/mV. The data obtained were compared between the groups.
Results: The mean age was 72.5(51.7-82.2) in group 1 and 74(68-79.7) in group 2, respectively. There was no significant difference between them (P= 0.593). In the study population, the ratio of males and females was similar between the groups. In ECG evaluation of the study population, no significant difference was found between atrial rate, ventricular rate, QRS duration, QTc duration and frequency of fragmented QRS (p<0.05). QTcd and Pd were significantly higher in Lyme + (Group 1). (75(56-84.5) vs 52(45-64.5), p=0.002; 58(50-62) vs 42.5(39-45.5), p<0.001, respectively).
Conclusion: When the results of our study are evaluated; Lyme disease causes an increase in Pd and QTcd in addition to affecting the AV node as known in the literature. These findings suggest that cardiac involvement of Lyme disease affects the cardiac conduction system more than thought.

Keywords

Lyme disease,, Electrocardiograpyh, AV complete block

Ethical Statement

Dear Editor, The original article entitled “Are ECG findings overlooked in Lyme disease, which is the cause of AV complete block?” having taken the consent of all authors has been sent on your assessment. Authors have no financial or any other kind of personal conflicts with this article. This paper has not been published in its current form or a substantially similar form (in print or electronically, including on a web site) and it has not been accepted for publication elsewhere, and that it is not under consideration by another publication. We hope this paper instructive for our colleagues. Yours faithfully, Corresponding Author: Osman BEKTAŞ M.D. Ordu University, Ordu, Turkey Phn num: [phone] Fax num: [phone] e-mail :[e-mail]

Project Number

2023/36

References

• Steere AC. Lyme disease. N Engl J Med. 2001 Jul 12;345(2):115-25. doi: 10.1056/NEJM200107123450207. PMID: 11450660.
• Weber K. Aspects of Lyme borreliosis in Europe. Eur J Clin Microbiol Infect Dis. 2001 Jan;20(1):6-13. doi: 10.1007/s100960000412. PMID: 11245327.
• Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012 Feb 4;379(9814):461-73. doi: 10.1016/S0140-6736(11)60103-7. Epub 2011 Sep 6. PMID: 21903253.
• Ciesielski CA, Markowitz LE, Horsley R, Hightower AW, Russell H, Broome CV. Lyme disease surveillance in the United States, 1983-1986. Rev Infect Dis. 1989 Sep-Oct;11 Suppl 6:S1435-41. PMID: 2682955.
• Pinto DS. Cardiac manifestations of Lyme disease. Med Clin North Am. 2002 Mar;86(2):285-96. doi: 10.1016/s0025-7125(03)00087-7. PMID: 11982302.
• Nau R, Christen HJ, Eiffert H. Lyme disease--current state of knowledge. Dtsch Arztebl Int. 2009 Jan;106(5):72-81; quiz 82, I. doi: 10.3238/arztebl.2009.0072. Epub 2009 Jan 30. PMID: 19562015; PMCID: PMC2695290.
• Steere AC, Batsford WP, Weinberg M, Alexander J, Berger HJ, Wolfson S, et al. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Intern Med. 1980 Jul;93(1):8-16. doi: 10.7326/0003-4819-93-1-8. PMID: 6967274.
• van der Linde MR: Lyme-carditis: clinical characteristics of 105cases. Scand J Infect Dis 1991; 77: 81–4.
• Lorincz I, Lakos A, Kovacs P: Temporary pacing in complete heart block due to lyme disease: a case report. PACE 1989; 12:1433–6.
• Mc Alister HF, Klementowicz C, Andrews JD, Fisher JD, Feld M, Furman S: Lyme carditis: an important cause of reversible heart block in lyme disease. Ann Intern Med 1989; 110: 339–45.
• Allal J, Coisne D, Thomas P, Vieyres C, Gallimard JF, Becq-Giraudon B, et al. Manifestations cardiaques de la maladie de Lyme [Cardiac manifestations of Lyme disease]. Ann Med Interne (Paris). 1986;137(5):372-4. French. PMID: 3813267.
• Mayer W, Kleber FX, Wilske B, Preac-Mursic V, Maciejewski W, Sigl H, et al. Persistent atrioventricular block in Lyme borreliosis. Klin Wochenschr. 1990 Apr 17;68(8):431-5. doi: 10.1007/BF01648587. PMID: 2348647.
• Artigao R, Torres G, Guerrero A, Jiménez-Mena M, Bayas Paredes M. Irreversible complete heart block in Lyme disease. Am J Med. 1991 Apr;90(4):531-3. PMID: 2012098.
• Duray PH: Clinical pathological correlations of Lyme disease. Rev Infect Dis 1989; 1 I :S 1487-93
• Canver CC, Chanda J, DeBellis DM, Kelley JM.: Possible relationship between degenerative card iac valvular pathology and Lyme disease. Ann Thorac Surg 2000; 70:283-5
• Horowitz HW, Belkin RN: Acute myopericarditis resulring from Lyıne disease. Am Heaıt J 1 995; I 30: 176-8
• Midttun M, Lebech AM, Hansen K, Videbaek J. Lyme carditis: A clinical presentation and longtime follow-up. Scand J infectDis 1997;29:153-7
• Day CP, McComb Jm, Campbell Rw. QT dispersion: an indication of arrhythmia risk in patients with long QT intervals. Br Heart J 1990;63:342-4.
• Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fi brillation. Am Heart J 1998; 135:733–8.
• Gialafos JE, Dilaveris PE, Gialafos EJ, GK Andrikopoulos, DJ Richter, F Triposkiadis et al. P dispersion: a valuable electrocardiographic marker for the prediction of paroxysmal lone atrial fibrillation. Ann Noninvasive Electrocardiol 1999; 4: 39–45.
• Yilmaz R, Demirbag R. P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol 2005; 38: 279–84.
• Dilaveris PE, Andrikopoulos GK, Metaxas G, Richter DJ, Avgeropoulou CK, Androulakis AM, et al. Effects of ischemia on P wave dispersion and maximum P wave duration during spontaneous anginal episodes. Pacing Clin Electrophysiol. 1999 Nov;22(11):1640-7. doi: 10.1111/j.1540-8159.1999.tb00384.x. PMID: 10598968.
• Weber UK, Osswald S, Huber M, Buser P, Skarvan K, Stulz P, et al. Selective versus nonselective antiarrhythmic approach for prevention of atrial fi brillation after coronary surgery: is there a need for preoperative risk stratifi cation? A prospective placebo-controlled study using low dose sotalol. Eur Heart J 1998; 19: 794–800. doi: 10.1053/euhj.1997.0838. PMID: 9717015.