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

Öz

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.

Anahtar Kelimeler

• Lyme disease,
• Electrocardiograpyh
• AV complete block

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

Öz

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.

Anahtar Kelimeler

• Lyme hastalığı
• Elektrokardiyografi
• AV tam blok

Kaynakça

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