Electrocardiograph abnormalities in children with lyme meningitis

Objective: The objective of the study was to estimate the prevalence of and identify risk factors for electrocardiographic (ECG) changes in children presenting with Lyme meningitis. Design: This was a cross-sectional study. Setting: The study was set in three large urban pediatric tertiary care centers. Participants: Children who were diagnosed with Lyme meningitis and underwent ECG testing were included. Outcome measure: The presence of an ECG abnormality associated with early-disseminated Lyme infection was the outcome measure. Results: Multivariable logistic regression was used to identify factors independently associated with ECG abnormalities. ECG testing was performed in 103 (66%) of 157 children with Lyme meningitis. The median age of these children was 10.8 years; 68% were male. ECG abnormalities, identified in 34 (33%) subjects, included one or more of the following: atrioventricular block (n = 16; 16%), ST-T wave changes (n = 14; 14%), and prolongation of the corrected QT interval (n = 11; 11%). In multivariate analysis, age ≥13 years and fever for ≥5 days were independently associated with ECG abnormalities. The probability of ECG abnormalities was greater than 50% in those with fever for ≥5 days or age ≥13 years, and if a subject fulfilled both criteria, the probability of ECG abnormalities was 83% (95% confidence interval: 50%-96%). Conclusions: Electrocardiographic abnormalities occur commonly in children with Lyme meningitis. While older children with prolonged fever were most likely to have such abnormalities, the clinical consequences of asymptomatic ECG abnormalities in children with Lyme meningitis are not known.