{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T20:07:25Z","timestamp":1784318845123,"version":"3.55.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T00:00:00Z","timestamp":1635897600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Lyme carditis, defined as direct infection of cardiac tissue by Borrelia bacteria, affects up to 10% of patients with Lyme disease. The most frequently reported clinical manifestation of Lyme carditis is cardiac conduction system disease. The goal of this study was to identify the incidence and predictors of permanent pacemaker implantation in patients hospitalized with Lyme disease.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective cohort analysis of the Nationwide Inpatient sample was performed to identify patients hospitalized with Lyme disease in the US between 2003 and 2014. Patients with Lyme carditis were defined as those hospitalized with Lyme disease who also had cardiac conduction disease, acute myocarditis, or acute pericarditis. Patients who already had pacemaker implants at the time of hospitalization (N = 310) were excluded from the Lyme carditis subgroup. The primary study outcome was permanent pacemaker implantation. Secondary outcomes included temporary cardiac pacing, permanent pacemaker implant, and in-hospital mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 96,140 patients hospitalized with Lyme disease during the study period, 10,465 (11%) presented with Lyme carditis. Cardiac conduction system disease was present in 9,729 (93%) of patients with Lyme carditis. Permanent pacemaker implantation was performed in 1,033 patients (1% of all Lyme hospitalizations and 11% of patients with Lyme carditis-associated conduction system disease). Predictors of permanent pacemaker implantation included older age (OR: 1.06 per 1 year; 95% CI:1.05\u20131.07; P&lt;0.001), complete heart block (OR: 21.5; 95% CI: 12.9\u201335.7; P&lt;0.001), and sinoatrial node dysfunction (OR: 16.8; 95% CI: 8.7\u201332.6; P&lt;0.001). In-hospital mortality rate was higher in patients with Lyme carditis (1.5%) than in patients without Lyme carditis (0.5%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Approximately 11% of patients hospitalized with Lyme disease present with carditis, primarily in the form of cardiac conduction system disease. In this 12-year study, 1% of all hospitalized patients and 11% of those with Lyme-associated cardiac conduction system disease underwent permanent pacemaker implantation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0259123","type":"journal-article","created":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T17:29:55Z","timestamp":1635960595000},"page":"e0259123","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":24,"title":["Incidence of carditis and predictors of pacemaker implantation in patients hospitalized with Lyme disease"],"prefix":"10.1371","volume":"16","author":[{"given":"Uwajachukwumma A.","family":"Uzomah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Rozen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed","family":"Mohammadreza 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Robinson","year":"2015","journal-title":"Infect Dis Clin North Am"},{"key":"pone.0259123.ref004","first-page":"589","article-title":"Cardiac manifestations of Lyme borreliosis","volume":"58","author":"P Grzesik","year":"2004","journal-title":"Przegl Epidemiol"},{"key":"pone.0259123.ref005","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1111\/j.1540-8159.1990.tb04009.x","article-title":"Acute Reversible Diffuse Conduction System Disease due to Lyme Disease","volume":"13","author":"DA Rubin","year":"1990","journal-title":"Pacing Clin Electrophysiol"},{"key":"pone.0259123.ref006","doi-asserted-by":"crossref","first-page":"8","DOI":"10.7326\/0003-4819-93-1-8","article-title":"Lyme Carditis: Cardiac Abnormalities of Lyme Disease","volume":"93","author":"AC Steere","year":"1980","journal-title":"Ann Intern Med"},{"key":"pone.0259123.ref007","doi-asserted-by":"crossref","first-page":"e451","DOI":"10.1161\/CIRCULATIONAHA.112.101485","article-title":"Lyme Disease and the Heart","volume":"127","author":"PJ Krause","year":"2013","journal-title":"Circulation"},{"key":"pone.0259123.ref008","first-page":"81","article-title":"Lyme carditis: clinical characteristics of 105 cases","volume":"77","author":"MR van der Linde","year":"1991","journal-title":"Scand J Infect Dis"},{"key":"pone.0259123.ref009","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/0002-8703(91)90589-A","article-title":"Cardiovascular manifestations of Lyme disease","volume":"122","author":"J Cox","year":"1991","journal-title":"Am Heart J"},{"key":"pone.0259123.ref010","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1093\/cid\/ciu411","article-title":"Third-Degree Heart Block Associated With Lyme Carditis: Review of Published Cases","volume":"59","author":"JD Forrester","year":"2014","journal-title":"Clin Infect Dis"},{"key":"pone.0259123.ref011","doi-asserted-by":"crossref","first-page":"339","DOI":"10.7326\/0003-4819-110-5-339","article-title":"Lyme Carditis: An Important Cause of Reversible Heart Block","volume":"110","author":"HF McAlister","year":"1989","journal-title":"Ann Intern Med"},{"key":"pone.0259123.ref012","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1086\/508667","article-title":"The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America","volume":"43","author":"GP Wormser","year":"2006","journal-title":"Clin Infect Dis"},{"key":"pone.0259123.ref013","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1086\/314053","article-title":"Practice Guidelines for the Treatment of Lyme Disease","volume":"31","author":"GP Wormser","year":"2000","journal-title":"Clin Infect Dis"},{"key":"pone.0259123.ref014","unstructured":"Agency for Healthcare Research and, Quality. Introduction To the HCUP National Inpatient Sample (NIS). Published 2015. Accessed June 10, 2020. https:\/\/www.hcup-us.ahrq.gov\/db\/nation\/nis\/NIS_Introduction_2014.jsp."},{"key":"pone.0259123.ref015","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1097\/MLR.0000000000000793","article-title":"Identifying Increased Risk of Readmission and In-hospital Mortality Using Hospital Administrative Data","volume":"55","author":"A De Giorgi","year":"2017","journal-title":"Med Care"},{"key":"pone.0259123.ref016","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity Measures for Use with Administrative Data","volume":"36","author":"A Elixhauser","year":"1998","journal-title":"Med Care"},{"key":"pone.0259123.ref017","article-title":"Nationwide Inpatient Sample (NIS) Redesign Final Report","author":"R Houchens","year":"2014","journal-title":"HCUP Methods Series Report"},{"key":"pone.0259123.ref018","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1002\/sim.4780040112","article-title":"A wilcoxon-type test for trend","volume":"4","author":"J. Cuzick","year":"1985","journal-title":"Stat Med"},{"key":"pone.0259123.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss6622a1","article-title":"Surveillance for lyme disease\u2014United States, 2008\u20132015","volume":"66","author":"AM Schwartz","year":"2017","journal-title":"MMWR Surveill Summ"},{"key":"pone.0259123.ref020","unstructured":"CDC. Lyme Disease Data. Lyme Disease. https:\/\/www.cdc.gov\/lyme\/stats\/tables.html. Published 2012. Accessed June 10, 2020."},{"key":"pone.0259123.ref021","unstructured":"Centers for Disease Control and Prevention. Lyme Disease Maps: Historical Data. Cdc. https:\/\/www.cdc.gov\/lyme\/stats\/maps.html. Published 2019. Accessed June 10, 2020."},{"key":"pone.0259123.ref022","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.jacc.2018.11.035","article-title":"Diagnosis and Treatment of Lyme Carditis","volume":"73","author":"C Yeung","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"pone.0259123.ref023","doi-asserted-by":"crossref","first-page":"e64110","DOI":"10.1371\/journal.pone.0064110","article-title":"Gender Disparity between Cutaneous and Non-Cutaneous Manifestations of Lyme Borreliosis","volume":"8","author":"F Strle","year":"2013","journal-title":"PLoS One"},{"key":"pone.0259123.ref024","first-page":"111","article-title":"Lyme carditis","volume":"39","author":"J B\u0142aut-Jurkowska","year":"2015","journal-title":"Pol Merkur Lekarski"},{"key":"pone.0259123.ref025","first-page":"339","article-title":"Cardiac manifestations of Lyme disease","volume":"93","author":"TJ Earl","year":"2010","journal-title":"Med Health R I"},{"key":"pone.0259123.ref026","first-page":"430","article-title":"Lyme carditis\u2014rare cause of dilated cardiomyopathy and rhythm disturbances","volume":"54","author":"J. Cepelov\u00e1","year":"2008","journal-title":"Vnitr Lek"},{"key":"pone.0259123.ref027","first-page":"202","article-title":"Lyme Carditis","volume":"112","author":"N Scheffold","year":"2015","journal-title":"Dtsch Aerzteblatt Online"},{"key":"pone.0259123.ref028","first-page":"503","article-title":"Cardiac manifestations of Lyme disease: A review","volume":"93","author":"KS Nagi","year":"1996","journal-title":"Can J Cardiol"},{"key":"pone.0259123.ref029","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.amjmed.2017.11.004","article-title":"Without Further Delay: Lyme Carditis","volume":"131","author":"AK Sharma","year":"2018","journal-title":"Am J Med"},{"key":"pone.0259123.ref030","first-page":"367","article-title":"Complete heart block due to lyme carditis","volume":"15","author":"R Lo","year":"2003","journal-title":"J Invasive Cardiol"},{"key":"pone.0259123.ref031","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.amjcard.2018.01.026","article-title":"Lyme Carditis and High-Degree Atrioventricular Block","volume":"121","author":"D Wan","year":"2018","journal-title":"Am J Cardiol"},{"key":"pone.0259123.ref032","first-page":"21","article-title":"A case of lyme carditis with atrioventricular block and review of the literature","volume":"35","author":"I Christova","year":"2007","journal-title":"Probl Infect Parasit Dis"},{"key":"pone.0259123.ref033","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1016\/0002-8703(91)90173-F","article-title":"Ventricular tachycardia associated with Lyme carditis","volume":"121","author":"SC Vlay","year":"1991","journal-title":"Am Heart J"},{"key":"pone.0259123.ref034","doi-asserted-by":"crossref","first-page":"56","DOI":"10.5114\/reum.2013.33396","article-title":"Cardiac implications of Lyme borreliosis","volume":"1","author":"E. Maroszy\u0144ska-Dmoch","year":"2013","journal-title":"Reumatologia\/Rheumatology"},{"key":"pone.0259123.ref035","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.2741\/1065","article-title":"Lyme disease and the heart","volume":"8","author":"RB Nadelman","year":"2003","journal-title":"Front Biosci"},{"key":"pone.0259123.ref036","first-page":"e24","article-title":"Acute Heart Failure From Lyme Carditis","volume":"5","author":"R Koene","year":"2012","journal-title":"Circ Hear Fail"},{"key":"pone.0259123.ref037","first-page":"350","article-title":"ACC\/AHA Task Force on Practice Guidelines (Writing Committee to Revise the ACC\/AHA\/NASE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices, AATS, STS. ACC\/AHA\/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities A Report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC\/AHA\/NASPE 2002 Guidelines)","volume":"117","author":"AE Epstein","year":"2008","journal-title":"Circulation"},{"key":"pone.0259123.ref038","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/BF01648587","article-title":"Persistent atrioventricular block in Lyme borreliosis","volume":"68","author":"W Mayer","year":"1990","journal-title":"Klin Wochenschr"},{"key":"pone.0259123.ref039","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/0002-9343(91)90619-9","article-title":"Irreversible complete heart block in Lyme disease","volume":"90","author":"R Artigao","year":"1991","journal-title":"Am J Med"},{"key":"pone.0259123.ref040","first-page":"313","article-title":"Lyme carditis: Complete atrioventricular dissociation with need for temporary pacing","volume":"47","author":"T Xanthos","year":"2006","journal-title":"Hell J Cardiol"},{"key":"pone.0259123.ref041","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1002\/clc.23102","article-title":"Suspicious index in Lyme carditis: Systematic review and proposed new risk score.","volume":"41","author":"G Besant","year":"2018","journal-title":"Clin Cardiol"},{"key":"pone.0259123.ref042","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1016\/j.jacc.2006.01.006","article-title":"Modified Temporary Cardiac Pacing Using Transvenous Active Fixation Leads and External Re-Sterilized Pulse Generators","volume":"47","author":"PC Zei","year":"2006","journal-title":"J Am Coll Cardiol"},{"key":"pone.0259123.ref043","first-page":"8","article-title":"Leadless pacemaker used as long-term temporary therapy in Lyme carditis with high-grade atrioventricular block.","volume":"21","author":"A Isath","year":"2019","journal-title":"EP Eur"},{"key":"pone.0259123.ref044","doi-asserted-by":"crossref","first-page":"e12599","DOI":"10.1111\/anec.12599","article-title":"Treating Lyme carditis high\u2010degree AV block using a temporary\u2013permanent pacemaker","volume":"24","author":"C Wang","year":"2019","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"pone.0259123.ref045","doi-asserted-by":"crossref","first-page":"3652","DOI":"10.19102\/icrm.2019.100506","article-title":"A Review of Temporary Permanent Pacemakers and a Comparison with Conventional Temporary Pacemakers","volume":"10","author":"K Suarez","year":"2019","journal-title":"J Innov Card Rhythm Manag"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259123","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T17:30:25Z","timestamp":1635960625000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259123"}},"subtitle":[],"editor":[{"given":"Simone","family":"Savastano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,11,3]]},"references-count":45,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0259123","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,3]]}}}