Korean Circ J.  2016 Mar;46(2):260-263. 10.4070/kcj.2016.46.2.260.

Cardiac Metastasis of Leiomyosarcoma Complicated with Complete Atrio-Ventricular Block and Ventricular Tachycardia

• Park YM
• Shin JO
• Kim M
• Kang WC
• Moon J
• Chung WJ
• Sung YM

• KMID: 2344479
• DOI: http://doi.org/10.4070/kcj.2016.46.2.260

Abstract

We described a case of a 54-year-old male who presented with dizziness and dyspnea due to cardiac metastasis of leiomyosarcoma. Cardiac metastasis of leiomyosarcoma caused both bradyarrhythmia and tachyarrhythmia in the patient. He was treated with implantation of a permanent pacemaker for management of complete atrio-ventricular block and anti-arrhythmic drug that suppressed ventricular tachycardia successfully.

Keyword

Leiomyosarcoma; Neoplasm, metastasis; Heart; Atrioventicular block; Tachycardia, ventricular

MeSH Terms

Bradycardia
Dizziness
Dyspnea
Heart
Humans
Leiomyosarcoma*
Male
Middle Aged
Neoplasm Metastasis*
Tachycardia
Tachycardia, Ventricular*

Figure

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  Fig. 1 ECG reveals complete atrio-ventricular block and idioventricular escaped rhythm of bifascicular block morphology suggesting infrahisian block with a ventricular rate of 42 beats per minute. ECG: electrocardiography.

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  Fig. 2 Cardiac MRI reveals huge interventricular mass (67×35 mm) with low signal intensity, similar to the myocardium on the T1-weighted image (A) and mild higher signal intensity compared with the myocardium on the T2-weighted image (B) with multiple pulmonary lesions (white arrows). After enhancement with gadolinium, the tumor in the interventricular septum shows peripheral enhancement (white arrowheads) (C) and pulmonary metastatic nodules are enhanced well (white arrows). MRI: magnetic resonance imaging.

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  Fig. 3 Twelve-lead ECG shows wide QRS complex tachycardia, left bundle branch block pattern with left superior axis morphology and late transition that is compatible with VT from RV apex. ECG: electrocardiography, VT: ventricular tachycardia, RV: right ventricular.

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  Fig. 4 Twelve-lead ECG shows atrial sensing and ventricular paced rhythm after implantation of permanent pacemaker. Paced 12-lead QRS morphology is different from that of VT. ECG: electrocardiography, VT: ventricular tachycardia.

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  Fig. 5 Intracardiac electrograms (top; atrial electrogram, center; ventricular electrogram) and marker channel (bottom) shows the initiation of tachycardia with ventricular sensing (arrow) and the tachycardia shows VA dissociation. Pacemaker interrogation excludes pacing-induced VT or pacemaker-mediated tachycardia. VT: ventricular tachycardia.

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