Suspicious index in Lyme carditis: Systematic review and proposed new risk score
Georgia Besant
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorDouglas Wan
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorCynthia Yeung
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorCrystal Blakely
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorPamela Branscombe
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorLaiden Suarez-Fuster
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorDamian Redfearn
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorChristopher Simpson
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorHoshiar Abdollah
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorBenedict Glover
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorCorresponding Author
Adrian Baranchuk
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Correspondence
Adrian Baranchuk, MD, FACC, FRCPC, FCCS, Professor of Medicine, Clinical Electrophysiology and Pacing, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
Email: [email protected]
Search for more papers by this authorGeorgia Besant
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorDouglas Wan
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorCynthia Yeung
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorCrystal Blakely
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorPamela Branscombe
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorLaiden Suarez-Fuster
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorDamian Redfearn
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorChristopher Simpson
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorHoshiar Abdollah
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorBenedict Glover
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Search for more papers by this authorCorresponding Author
Adrian Baranchuk
Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
Correspondence
Adrian Baranchuk, MD, FACC, FRCPC, FCCS, Professor of Medicine, Clinical Electrophysiology and Pacing, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Lyme carditis (LC), an early manifestation of Lyme disease that most commonly presents as high-degree atrioventricular block (AVB), usually resolves with antibiotic treatment. When LC is not identified as the cause of AVB, a permanent pacemaker may be inappropriately implanted in a reversible cardiac conduction disorder.
Hypothesis
The likelihood that a patient's high-degree AVB is caused by LC can be evaluated by clinical characteristics incorporated into a risk stratification tool.
Methods
A systematic review of all published cases of LC with high-degree AVB, and five cases from the authors' experience, was conducted. The results informed the development of a new risk stratification tool, the Suspicious Index in LC (SILC) score. The SILC score was then applied to each case included in the review.
Results
Of the 88 cases included, 51 (58%) were high-risk, 31 (35.2%) intermediate-risk, and 6 (6.8%) low-risk for LC according to the SILC score (sensitivity 93.2%). For the subset of 32 cases that reported on all SILC variables, 24 (75%) cases were classified as high-risk, 8 (25%) intermediate-risk, and 0 low-risk (sensitivity 100%). Specificity could not be assessed (no control group). Notably, 6 of the 11 patients who received permanent pacemakers had reversal of AVB with antibiotic treatment.
Conclusion
The SILC risk score and COSTAR mnemonic (constitutional symptoms; outdoor activity; sex = male; tick bite; age < 50; rash = erythema migrans) may help to identify LC in patients presenting with high-degree AVB, and ultimately, minimize the implantation of unnecessary permanent pacemakers.
CONFLICTS OF INTEREST
The authors declare no potential conflict of interests.
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