Clinical Manifestations
- Occurs during early disseminated Lyme disease (14-21 days following inoculation)
Management
- Treat per Borrelia burgdorferi
- Hospitalization recommended for those at risk of severe complications
- PR > 300 ms, arrhythmias, myopericarditis
- Continuous ECG monitoring
- For symptomatic bradycardia refractory to medical management, use temporary rather than permanent pacing
- Prefer oral antibiotics in general (doxycycline, amoxicillin, cefuroxime, or azithromycin)
- If hospitalized, start with ceftriaxone before stepping down to oral
- Duration of 14 to 21 days
- About half need temporary pacing
- Third-degree heart block resolves with treatment and they do not need a pacemaker
