Lyme Borreliosis-Associated Carditis: Contemporary Perspectives on Pathogenesis, Clinical Manifestations, And Evolving Management Paradigms in the Context of Persistent Immunological Sequelae

Abstract

Lyme disease, a multisystem infectious process instigated by the spirochete Borrelia burgdorferi sensu lato complex, remains a formidable clinical entity due to its protean systemic manifestations. Cardiac involvement, termed Lyme carditis, represents an uncommon yet potentially critical complication of disseminated early infection, characterized by spirochetal infiltration of cardiac tissues precipitating a spectrum of conduction abnormalities and myocardial inflammation. This article synthesizes contemporary understanding of the molecular pathogenesis underlying Borrelia-mediated cardiotropism, focusing on post-infectious inflammatory cascades and potential persistent immunogenic stimuli. Clinical presentation is critically examined, emphasizing the diagnostic challenges posed by variable symptomology ranging from subclinical conduction delays to high-grade atrioventricular block and, rarely, myopericarditis. The discourse advances to a nuanced analysis of current therapeutic strategies, juxtaposing guideline-recommended antibiotic regimens against complex presentations necessitating advanced cardiac interventions, such as temporary pacing. Furthermore, the manuscript engages with emergent debates concerning post-treatment Lyme disease syndrome (PTLDS) and its potential cardiological correlates, a domain requiring further delineation. By integrating recent epidemiological data and advanced diagnostic modalities, including serological interpretation and novel imaging techniques, this review aims to provide a comprehensive, evidence-based framework for the recognition and management of this intriguing cardioneuropathic syndrome, thereby mitigating the risk of long-term cardiac morbidity.