Glad to hear you are doing all right. Your question is a good one, but it is beyond my knowledge. I suggest you go to the ILADS [dot] org website and search for 'heart block' -- there are many 'hits' in the search I just did there. The ILADS guidelines for diagnosis and treatment have several versions; there is apparently one under revision now and it has not been posted yet, and it is confusing to read so many drafts etc. on the ILADS website. However if you go to www [dot] ilads [dot] org / news / Educational /69 [dot] html, it will explain the current state of standard of care recommendations from ILADS, which are in draft version. I would suggest you read through all the versions, searching for 'heart block', and see what you find.
Here is information from the *2000* Guidelines, which may or may not be outdated; I don't have the time to sort through all the versions since then, which is why I refer you to the link in the previous paragraph, so that you can do so yourself. Here is a quote from those 2000 Guidelines:
"Patients with first- or second-degree atrioventricular heart block associated with early Lyme disease should be treated in the same manner as patients with erythema migrans without carditis (B-III). We recommend that patients with third-degree atrioventricular heart block be treated with parenteral antibiotics such as ceftriaxone in the hospital, although there are no clinical trial data to support this recommendation (B-III). A temporary pacemaker may also be required."
The "B-III" references in that quote are tags to indicate how strong the evidence is for that recommendation. Here is a key to what "B" and "III" mean:
Quality of evidence:
I Evidence from at least one properly randomized, controlled trial
II Evidence from at least one well-designed clinical trial without randomization, from cohort or case-control analytic studies (preferably from more than one center), from multiple time-series studies, or from dramatic results of uncontrolled experiments.
III Evidence from opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.
Strength of recommendation
A Good evidence to support a recommendation for use
B Moderate evidence to support a recommendation for use
C Poor evidence to support a recommendation
D Moderate evidence to support a recommendation against use
E Good evidence to support a recommendation against use
DATE RELEASED: 2000 July
It is a fair question to go back to your doctor and ask these questions. The doctor should have a reasoned explanation and tell you on what basis s/he made the recommendations you received.
Best wishes --
Well, it is not so alright, more questions than answers.
As example that sick sinus syndrome (SSS) diagnosis, it may be need of pacemaker but cardiologist did not even mentioned this diagnosis twice. And Lyme can mimic sinus Sick Sinus Syndrome so it may be misdiagnosis as well.
And can heart block persist 5 years long undiagnosed Lyme and reverse after treatment?
If cardiologist is right then i am very, very, VERY rare example of Lyme victim!
You make good points, which are beyond my understanding of Lyme effect on the heart. If your doctor is open-minded, then doing research online on these points you raise (such as Lyme vs Sick Sinus Syndrome) on MedLine and in medical journals (which MedLine summaries link to) and then presenting your research to your doctor may be quite productive in understanding and agreement on a treatment approach for you. From your posts that I have read, you are well equipped to do the research and make the points with your doctor.
Considering how the bacteria have sort of melted off me, under the skin, I can envision such things happening internally too. There's a question of just what that blockage is composed of. Mycoplasmas, and lots of other micro-vermin seem to like the environment of the heart. A mycoplasma colony would be very hard to differentiate from a fatty deposit, since their exterior is composed of sterols and cholesterol.
Had to add to this as bartonella infects the endothelium, a thin layer of cells that lines the interior surface of blood vessels. Beat the bart, and chances of remission are pretty good for you. As I said above, it depends on what the composition of the blockage is.
One more thought -- are your magnesium levels where they should be? Lyme depletes magnesium (Mg), but blood tests are (so I read) not very accurate at tracking Mg, because most of it is held inside the body's cells and not floating in the bloodstream where it can be measured by a blood test.
One of my early signs of Lyme was heart irregularities that put me in the hospital emergency room twice in one week. Once given intravenous fluids (with electrolytes), I recovered very quickly, but no one bothered to look further into what caused the episodes.
Just a thought.
I still take Mg supplements every day. It's very soothing to the mind as well, and I have thought that perhaps some of the anxiety associated with Lyme is due to low Mg levels. That is just speculation on my part... but depletion of Mg by Lyme is a real thing. It's in the literature.
If you search online:
lyme magnesium depletion
you will find information.