Kingston Health Sciences Centre (KHSC) has detected three cases of Lyme Carditis in just the last two weeks and that is a major cause of concern, according to Dr. Adrian Baranchuk of Queen’s School of Medicine.
Lyme disease (LD) is a tick-borne bacterial infection caused by Borrelia burgdorferi that is endemic to the Kingston region and other parts of Canada and the USA. Dr. Barachuk explained, “the bacteria gets into your blood through the tick bite of specific ticks that are endemic in our region, Kingston. Then, once that happens, a process called early dissemination starts, which is within the first 30 to 60 days, [and] that bacteria has a preference to go to certain organs. When the bacteria goes to the heart, we call it Lyme Carditis.”(LC)
“The heart has three layers,” he explained, “It has a superficial layer, the pericardium, a middle layer called the myocardium, and an inner layer called the endocardium.”
“Now, in the endocardium,” he went on, “The heart has the electrical system.” If you think about the heart, he explained, it beats involuntarily, you don’t have to think about that muscle, the heart, to make it move. “Your heart will beat independent of your decisions. So, the bacteria seem to have a predilection for the electrical system of the heart,” Baranchuk said.
The bacterium can interfere with the normal movement of electrical signals from the heart’s upper to lower chambers, the process that coordinates the heartbeat. “And what this can produce in people — young and previously completely healthy people — is a complete shutdown of the electrical system. And if that happens, there are no cardiac beats or only a few beats per minute, in the ballpark of 20 to 30 beats per minute, which may maintain life, but doesn’t allow you to talk, to breathe, or to walk,” he explained.
Grimly, he said, “in the most dramatic form of Lyme Carditis, the shut down of the electrical system is complete.” In other words, sometimes the patient dies.
However, there is hope. If Lyme Carditis can be recognized and diagnosed quickly enough, he explained, “at least transiently, you have to put a temporary pacemaker in,” to maintain the patient’s heartbeat and treat the bacterial infection with antibiotics.
Unfortunately, this isn’t always what has been done, and sometimes even now a patient presenting with Lyme Carditis could have a permanent pacemaker implanted. This is problematic because LC can happen in young people and, “a pacemaker battery lasts eight to 10 years,” Baranchuk said. “So if I implant a 32-year-old gentleman, I may need to replace the battery over five or six times, right? Every time I replace the battery, there is a risk of two to three per cent of a serious infection,” which, in turn, means the entire system might have to be removed and replaced, he explained.
Further, a permanent pacemaker is not so easily removed. “You have a window of about 12 months to remove the pacemaker if you feel that this pacemaker has not been implanted for a good reason. After the 12 months, you need a laser system and that is done in Toronto and London, you need to transfer the patient, etc.,” he said.
Baranchuk explained with excitement that his team from Queen’s, “advanced a model that has been published, all around the world, in the highest impact factor cardiology journals.”
Their research found that a permanent pacemaker was superfluous in most cases. Instead, the team suggested that “a temporary permanent pacemaker,” was all that was required. “This is something that we can easily remove if the patient recovers,” explained the doctor.
“We just have the long-term follow-up of patients treated with Lyme Carditis, zero patients needed a permanent pacemaker. And in an average of almost a full two years, all of them are doing their normal life,”Barabchuk revealed, excitement and pride evident in his voice.
What was the game-changing factor in the team’s discovery and research? A happy coincidence.
As Dr. Baranchuk shared the story, two different men were diagnosed with Lyme Carditis. They were diagnosed at separate hospitals, in separate regions (neither of them at KHSC). Both had a permanent pacemaker implanted and were properly treated with three weeks of antibiotics.
Both men, for different reasons, ended up moving to Kingston and had pacemaker checkups at KHSC’s Cardiac Rythm Device Clinic (CRDC).
This is where Baranchuk got excited, “Now, listen to this: these patients got a ‘transient shutdown’ of their electricity. They were properly treated with antibiotics. And, since their implant to the day that they were seen by us at the CRDC, they had not used their permanent pacemaker.” That is to say, their hearts were working properly, their own natural electrical systems were pumping their hearts, without the added “spark” of the pacemaker.
“Both Patients were between four and six months since implant. So what did we do? Should we keep this pacemaker and say ‘so sorry, you’re gonna live the rest of your life with a pacemaker?’ Or should we entertain the idea that if their heart responds well to exercise and if they don’t have significant inflammation in the heart, we could remove these pacemakers and see how they are doing?” he posed.
“So we had long conversations with the patients. They understood the pros and cons of each decision, and both of them decided to have their pacemaker removed. So, we took both pacemakers out — one in April, one in May.”
The result? “Both patients are now perfectly healthy, doing their normal lives. And,” he went on with pride, “this is the first time in the history of medicine that, based on the understanding of how Lyme Carditis works, the pacemakers of these individuals were removed.”
This is why it is so important that he share this research, he expressed. “So much teaching, education, reaching the community through media is needed because we could have prevented the implant of the pacemakers, to begin with.”
He pointed out, “If the doctors were rock solid in the idea that if the patient is in the hospital, on a monitor, gets the antibiotics through IV in the hospital. And if you see a recovery under the strict parameters of what recovery means, then put the patient on a treadmill, if they are able to do a normal treadmill with no random alterations, you can send this patient home to complete three weeks of antibiotics. And you are saving all the conundrum of things that happen around the implant of a pacemaker because these patients will likely recover.”
This important research does not attenuate in any way Dr. Barachuk’s other advice to all that prevention is so much better than intervention.
“Please, use repellent and avoid endemic areas,” he implored, adding that, whether you are a patient with suspected Lyme disease or a doctor treating Lyme, “Please ask for an ECG.”