Neville et al reported using ECG changes to aid in the diagnosis of Lyme disease in children. The presence of these findings is consistent with Lyme carditis and so support the diagnosis of Lyme Disease. The authors are from multiple Children's Hospitals in the United States.
Patient selection: pediatric patient being evaluated for Lyme Disease in the Emergency Department
Factors predictive of Lyme carditis:
(1) presence of AV block (OR 4.7), with most being first degree (PR interval > 200 ms)
(2) other ECG evidence of carditis (OR 2.3)
Findings associated with carditis - new appearance of:
(1) AV block
(2) prolonged QTc
(3) ST or T wave changes
(4) left ventricular enlargement
(5) accelerated junctional rhythm
(6) early repolarization
(7) right bundle branch block (QRS duration > 120 ms)
These findings can aid in the management of a pediatric patient while Lyme disease testing is being performed.
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