Lyme carditis: Complete AV dissociation with episodic asystole presenting as syncope in the emergency department

We report a case of Lyme carditis in an otherwise-healthy young male who pr esented to the Emergency Department (ED) with syncope and a possible seizur e. This patient, without documented history of Lyme disease, acutely develo ped third-degree atrioventricular (AV) block with episodic asystole, which required placement of a transvenous pacemaker in the ED and resolved only a fter the patient had been placed on ceftriaxone. We discuss the significanc e of Lyme carditis and its increasing prevalence, and review the current li terature. We also recommend appropriate screening modalities for patients w ith known Lyme disease, or an atypical profile for cardiac abnormalities. ( C) 1999 Elsevier Science Inc.