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Lack of Cardiac Manifestations among Patients with Previously Treated Lyme Disease

Oliver Sangha, MD, MPH; Charlotte B. Phillips, RN, MPH; Kirsten E. Fleischmann, MD, MPH; Thomas J. Wang, MD; Anne H. Fossel; Robert Lew, PhD; Matthew H. Liang, MD, MPH; and Nancy A. Shadick, MD, MPH
[+] Article and Author Information

From Brigham and Women's Hospital, Boston, Massachusetts. Acknowledgments: The authors thank Mark Link, MD, for valuable advice and interpretation of electrocardiograms, Karin Fossel for expert data management, and Mary Scamman for help with manuscript preparation. Grant Support: In part by National Institutes of Health grants AR36308 and AR02033. Dr. Sangha is supported in part by a fellowship grant from the German Academic Exchange Service (DAAD). Dr. Shadick is a recipient of an Arthritis Foundation Arthritis Investigator Award. Requests for Reprints: Nancy A. Shadick, MD, MPH, PB2 Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Current Author Addresses: Drs. Shadick and Liang: PB2 Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(5):346-353. doi:10.7326/0003-4819-128-5-199803010-00002
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Background: Cardiac involvement is common in acute Lyme disease, and case reports suggest that cardiac abnormalities might also occur years after the primary infection.

Objective: To determine the prevalence of cardiac abnormalities in persons with previously treated Lyme disease.

Design: Population-based, retrospective cohort study with controls.

Setting: Nantucket Island, Massachusetts.

Participants: From among 3703 adult respondents to a total-population (n = 6046) mail survey, 336 (176 case-patients and 160 controls) were randomly selected for clinical evaluation.

Measurements: Current cardiac symptoms and major or minor abnormal electrocardiographic features, including heart rate; rhythm; axis; PR, QRS, and QT intervals; QRS structure; atrioventricular blocks; and ST-segment and T-wave changes.

Results: Persons with Lyme disease (case-patients, n = 176) (mean duration from disease onset to study evaluation, 5.2 years) and persons without evidence of previous Lyme disease (controls, n = 160) did not differ significantly in their patterns of current cardiac symptoms and electrocardiographic findings, including heart rate (P > 0.2), PR interval (P = 0.15), QRS interval (P > 0.2), QT interval (P > 0.2), axis (P > 0.2), presence of arrhythmias (P > 0.2), first-degree heart block (P = 0.12), bundle-branch block (P > 0.2), and ST-segment abnormalities (P > 0.2). In multivariate analyses that adjusted for age, sex, and previous heart disease, a history of previously treated Lyme disease was not associated with either major (odds ratio, 0.78; P > 0.2) or minor (odds ratio, 1.09; P > 0.2) electrocardiographic abnormalities.

Conclusion: Persons with a history of previously treated Lyme disease do not have a higher prevalence of cardiac abnormalities than persons without a history of Lyme disease.

Topics

lyme disease ; heart

Figures

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Figure 1.
Sampling strategy and study design used to determine case status and measure clinical and electrocardiographic outcomes in persons with and without previous Lyme disease.

*Adults 17 years of age and older. †Thirteen persons were excluded because of difficulties with electrocardiography or because the persons declined to be evaluated. CDC − Centers for Disease Control and Prevention.

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