Undetected Tick Bite Nearly Leads to Unnecessary Pacemaker Implantation in Kassel
A Kassel woman narrowly avoided an unnecessary pacemaker implantation thanks to the vigilance of a senior physician who inquired about potential tick exposure. The case highlights the growing concern of Lyme disease and its often-overlooked cardiac complications in Northern Hesse, Germany.
A 61-year-old resident of Kassel, Zuzanna Maciolek, was prepared for pacemaker surgery at the Helios clinics in Wehlheiden on Monday, September 8, 2025. However, senior physician Migena Ramaliu proactively asked about a history of tick bites, a question that ultimately altered the course of her treatment. Maciolek recalled a reddening around her knee joint in July, initially attributed to an insect bite.
“It’s crucial to consider all possibilities, especially in regions where tick-borne illnesses are prevalent,” stated a senior physician at Helios clinics. “A simple question can prevent a potentially harmful and ultimately unnecessary procedure.”
Maciolek had initially visited the Kassel Clinic emergency room on Saturday, September 6, 2025, experiencing dizziness. An electrocardiogram (EKG) revealed abnormalities, but she was discharged at her own request. Her condition worsened by Monday, prompting a visit to her family doctor, who then arranged for an ambulance to transport her to the Helios clinics. Upon arrival, her pulse was a dangerously low 40 beats per minute, accompanied by dizziness. Doctors initially diagnosed a third-degree AV block, a complete disruption of electrical signals between the heart’s chambers.
“We were facing a critical decision – whether to immediately implant a pacemaker,” explained Dr. Ole Breithardt, a cardiologist who was scheduled to perform the implantation. However, learning about the knee joint reddening and the patient’s subsequent report of headache and body aches prompted him to reconsider. He suspected Lyme disease, a bacterial infection transmitted by ticks.
To avoid delaying potentially life-saving treatment, doctors opted for a temporary solution. A pacemaker was externally positioned and inserted into the right heart via a vein in the area of the keybea, effectively “buying time” while awaiting laboratory results. “This allowed us to avoid intensive care monitoring while we investigated the possibility of Lyme disease,” Dr. Breithardt noted.
Within two days, the diagnosis of Lyme disease was confirmed, and Maciolek was treated with antibiotics. Her heart rhythm has since normalized, and the external pacemaker was successfully removed on Thursday, September 11, 2025. Dr. Breithardt emphasized that had the pacemaker been permanently implanted, its removal would have been a complex undertaking.
The case underscores a growing trend in Northern Hesse. According to medical professionals, instances of Lyme disease contracted from tick bites have been increasing in recent years, even within urban areas. Dr. Breithardt intends to raise awareness among his colleagues, urging them to consider tick-borne illnesses in patients presenting with similar symptoms.
He cautioned that the classic “bullseye” rash associated with Lyme disease doesn’t always appear. “Many people assume a red ring will always form after a tick bite, but this isn’t always the case. Sometimes there’s only redness, or no visible sign at all.” He advises individuals at risk of tick exposure, such as those who enjoy forest walks, to consult their doctor if they experience limb pain or headaches.
Maciolek, a nurse herself, expressed her gratitude and newfound awareness. She hadn’t initially connected her knee redness to a tick bite and is now more vigilant about the risks. She has already encouraged her husband to seek medical attention after he experienced tick bites in the past.
Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by the bacterium Borrelia burgdorferi. In Germany, the infection is transmitted to humans through the bite of infected ticks. The bacteria reside in the tick’s intestine and are typically transmitted 16 to 24 hours after the tick begins feeding on a host’s blood. .
This case serves as a critical reminder for healthcare providers and the public alike: a thorough patient history, including questions about potential tick exposure, can be life-saving.
