Risk of cardiac conduction disorders, and pacemaker implantations among individuals tested for serum Borrelia burgdorferi antibodies, a nationwide, matched, population-based cohort study

Malte M. Tetens*, Lars Haukali Omland, Ram B. Dessau, Svend Ellermann-Eriksen, Nanna S. Andersen, Charlotte Sværke Jørgensen, Christian Østergaard, Jacob Bodilsen, Kirstine K. Søgaard, Jette Bangsborg, Alex Christian Nielsen, Jens Kjølseth Møller, Ming Chen, Jesper Hastrup Svendsen, Niels Obel, Anne Mette Lebech

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Objectives: To investigate the short- and long-term risks of atrioventricular block and other cardiac conduction disorders associated with being tested for Borrelia burgdorferi (Bb) antibodies or Bb seropositivity as measures of confounding by indication and Bb infection, respectively. Methods: We performed a nationwide population-based matched cohort study (Denmark, 1993–2021). We included 52 200 Bb-seropositive individuals (stratified as only Bb-IgM-seropositive [n = 26 103], only Bb-IgG-seropositive [n = 18 698], and Bb-IgM-and-IgG-seropositive [n = 7399]) and two age- and sex-matched comparison cohorts: 104 400 Bb-seronegative individuals and 261 000 population controls. We investigated the risk associated with being tested for serum Bb antibodies and being Bb seropositive. Outcomes were atrioventricular block and other conduction disorders. We calculated short-term odds ratios (aOR) (within 1 month), and long-term hazard ratios (aHR) (after 1 month) adjusted for age, sex, diabetes, chronic heart failure, and kidney disease with 95% CI. Results: Compared with population controls, individuals tested for Bb antibodies had increased short- and long-term risks of atrioventricular block (aOR 47.9, 95% CI: 30.0–76.7, aHR 1.3, 95% CI:1.2–1.3), and other conduction disorders (aOR 18.2, 95% CI: 10.1–32.8, aHR 1.2, 95% CI: 1.1–1.4). Compared with Bb-seronegative individuals, only Bb-IgM-and-IgG-seropositive individuals had increased short-term risk of atrioventricular block (aOR: 2.1, 95% CI: 1.5–3.1). Discussion: The results suggest that Bb antibody testing is included in the diagnostic work-up of conduction disorders. Finally, that Bb seropositivity is not associated with other conduction disorders than atrioventricular block or with increased long-term risk of conduction disorders.

Original languageEnglish
JournalClinical Microbiology and Infection
Volume30
Issue number5
Pages (from-to)621-629
ISSN1198-743X
DOIs
Publication statusPublished - May 2024

Keywords

  • Atrioventricular block
  • Borrelia burgdorferi sensu lato
  • Borreliosis
  • Cardiac conduction system disease
  • Cohort study
  • Lyme disease
  • Serology
  • Immunoglobulin G/blood
  • Humans
  • Antibodies, Bacterial/blood
  • Middle Aged
  • Atrioventricular Block/immunology
  • Risk Factors
  • Male
  • Lyme Disease/epidemiology
  • Pacemaker, Artificial
  • Borrelia burgdorferi/immunology
  • Cardiac Conduction System Disease/immunology
  • Aged, 80 and over
  • Female
  • Adult
  • Aged
  • Cohort Studies

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