Lyme Carditis Causing Polymorphic Ventricular Tachycardia and Cardiogenic Shock

Background: Lyme carditis may cause complete heart block (CHB) usually at the level of the atrioventricular node, but rarely other arrhythmias. Case Summary: A 34-year-old man presented with chest pain and shortness of breath. An electrocardiogram revealed CHB. He had an episode of polymorphic ventricular tachycardia (PMVT) arrest requiring extracorporeal membrane oxygenation. A temporary transvenous pacemaker was inserted. Lyme IgM antibodies were positive; the patient was treated with antibiotics. Despite administration of antiarrhythmic agents, PMVT recurred. A subcutaneous implantable cardioverter-defibrillator was ultimately implanted. Discussion: This case highlights a rare presentation of Lyme carditis resulting in CHB with subsequent PMVT and severe biventricular failure necessitating mechanical circulatory support. The literature suggests that patients usually have resolution on antibiotic therapy with pacing rarely needed. Temporary pacing bridged our patient, and a subcutaneous implantable cardioverter-defibrillator was implanted because of recurrent PMVT. Take-Home Message: PMVT and cardiogenic shock are rare complications of Lyme carditis.