Benign cardiac tumours, malignant arrhythmias

Abstract

Four cases of pediatric cardiac tumours (PCTs) associated with ventricular arrhythmias are reported. Sudden cardiac death attributable to the tumour occurred in two children. A third child received an implantable cardioverter defibrillator and the fourth had persistent ventricular arrhythmia despite medical therapy. Most PCTs are considered benign; however, the development of malignant arrhythmias may complicate the management of these tumours in some patients. The literature regarding the arrhythmogenic potential of PCTs and the use of implantable cardioverter defibrillators in these patients is reviewed. The series highlights the deficiency of prognostic information for this cohort.

Figure 1)

Cardiac magnetic resonance images demonstrating a large fibroma high in an interventricular septum splaying both outflow tracts but producing no outflow tract obstruction

Figure 2)

A Apical four-chamber two-dimensional echocardiographic image demonstrating a large myxoma arising from the anterolateral atrial wall obstructing right ventricular inflow. B Modified parasternal long-axis two-dimensional echocardiographic view demonstrating the myxoma obstructing the tricuspid valve and right ventricular inflow

Figure 3)

Parasternal short-axis image at the level of the left ventricular papillary muscles demonstrating the paradoxical rightward movement of the thinned anteroseptal wall in systole (arrow). This portion of the septum was the location of the rhabdomyoma that had regressed spontaneously

Figure 4)

A A 12-lead electrocardiogram with rhythm strip illustrating monomorphic ventricular tachycardia at a ventricular rate of 130 beats/min with right bundle branch block morphology and a superior axis suggesting an origin in the left ventricular apical region. B Ambulatory Holter monitor recording from the same patient displaying a 5 s salvo of monomorphic ventricular tachycardia converting to normal sinus rhythm in the last two recorded beats