Ventricular Tachycardia Associated with Radiation-Induced Cardiac Sarcoma

Cardiac tumors can lead to distinct electrocardiographic changes and ventricular arrhythmias. Benign and malignant cardiac tumors have been associated with ventricular tachycardia. When possible, benign tumors should be resected when ventricular arrhythmias are intractable. Chemotherapy can shrink malignant tumors and eliminate arrhythmias. We report the case of a 52-year-old woman with breast sarcoma whom we diagnosed with myocardial metastasis after she presented with palpitations. The initial electrocardiogram revealed sinus rhythm with new right bundle branch block and ST-segment elevation in the anterior precordial leads. During telemetry, hemodynamically stable, sustained ventricular tachycardia with right ventricular localization was detected. Images showed a myocardial mass in the right ventricular free wall. Amiodarone suppressed the arrhythmia. To our knowledge, this is the first report of ventricular tachycardia associated with radiation-induced undifferentiated sarcoma. We discuss the distinct electrocardiographic changes and ventricular arrhythmias that can be associated with cardiac tumors, and we review the relevant medical literature.

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Canine Spindle Cell Mammary Tumor: A Retrospective Study of 67 Cases

Veterinary Pathology ◽

10.1177/0300985819829522 ◽

2019 ◽

Vol 56 (4) ◽

pp. 526-535

Author(s):

Ángela Alonso-Diez ◽

Antonio Ramos ◽

Paola Roccabianca ◽

Lucía Barreno ◽

Mª Dolores Pérez-Alenza ◽

...

Keyword(s):

Mammary Tumor ◽

Spindle Cell ◽

Malignant Tumors ◽

Smooth Muscle Actin ◽

Benign Tumors ◽

High Survival ◽

Nerve Sheath Tumor ◽

Canine Mammary Tumor ◽

Ki 67 ◽

Undifferentiated Sarcoma

Canine spindle cell mammary tumor (CSCMT) is an infrequent canine mammary tumor (CMT) composed of spindle or fusiform cells, which represents a challenge for pathologists and clinicians. Mammary tumors submitted for histopathology from 1998 to 2013 and compatible with CSCMTs were retrospectively selected. The tumors were diagnosed based on the hematoxylin and eosin (HE)–stained section; malignant tumors were graded using a canine soft tissue sarcoma grading scheme and a canine mammary tumor grading scheme, and they were further assigned a diagnosis based on immunohistochemistry (IHC) for pancytokeratin, cytokeratin 14, p63, calponin, vimentin, Ki-67, CD31, desmin, myosin, smooth muscle actin, glial fibrillary acidic protein, and S-100. The origin of the tumors was assessed as mammary, skin, or unknown. The prevalence of CSCMT was 1% of all CMTs. CSCMTs included 3 benign tumors (1 angioma and 2 benign myoepitheliomas) and 67 malignant tumors that after IHC were diagnosed as malignant myoepithelioma (64%), carcinoma and malignant myoepithelioma (19%), hemangiosarcoma (8%), undifferentiated sarcoma (5%), peripheral nerve sheath tumor (3%), and fibrosarcoma (2%). The diagnosis based on the HE-stained section differed from the diagnosis after IHC in 75% of the malignant cases. The majority of malignant CSCMTs were solitary (57%) large tumors (6.42 ± 3.92 cm) with low metastatic potential and high survival rate (8% tumor-related mortality). Higher sarcoma grade was associated with older age ( P = .034) and greater tumor size ( P = .037). Malignant CSCMTs need to be evaluated by IHC to ensure the histotype and the relatively benign clinical behavior, despite their large size.

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Arrhythmogenic right ventricular cardiomyopathy: management of symptoms and prevention of sudden cardiac death

10.1093/med/9780198784906.003.0361 ◽

2018 ◽

Author(s):

Perry Elliott ◽

Alexandros Protonotarios

Keyword(s):

Heart Failure ◽

Ventricular Tachycardia ◽

Right Ventricular ◽

Ventricular Arrhythmias ◽

Ventricular Dysfunction ◽

Beta Blockers ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Sustained Ventricular Tachycardia ◽

Carrier Status ◽

Ventricular Cardiomyopathy

Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have arrhythmia-related symptoms or are identified during screening of an affected family. Heart failure symptoms occur late in the disease’s natural history. As strenuous exercise has been associated with disease acceleration and worsening of ventricular arrhythmias, lifestyle modification with restricted athletic activities is recommended upon disease diagnosis or even identification of mutation carrier status. An episode of an haemodynamically unstable, sustained ventricular tachycardia or ventricular fibrillation as well as severe systolic ventricular dysfunction constitute definitive indications for implantable cardioverter defibrillator (ICD) implantation, which should also be considered following tolerated sustained or non-sustained ventricular tachycardia episodes, syncope, or in the presence of moderate ventricular dysfunction. Antiarrhythmic medications are used as an adjunct to device therapy. Catheter ablation is recommended for incessant ventricular tachycardia or frequent appropriate ICD interventions despite maximal pharmacological therapy. Amiodarone alone or in combination with beta blockers is most effective for symptomatic ventricular arrhythmias. Beta blockers are considered for use in all patients with a definite diagnosis but evidence for their prognostic benefit is sparse. Heart failure symptoms are managed using standard protocols and heart transplantation is considered for severe ventricular dysfunction or much less commonly uncontrollable ventricular arrhythmias.

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P992Incidence, predictors, and success of ventricular tachycardia catheter ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC): A long-term cohort study from the Nordic ARVC registry

European Heart Journal ◽

10.1093/eurheartj/ehz747.0585 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M K Christiansen ◽

K Haugaa ◽

A Svensson ◽

T Gilljam ◽

T Madsen ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Right Ventricular ◽

Ventricular Arrhythmias ◽

Task Force ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Young Age ◽

Clinical Indication ◽

Ventricular Cardiomyopathy ◽

Vt Ablation

Abstract Background Catheter ablation may reduce ventricular tachycardia (VT) burden in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. However, little is known about factors predicting need for ablation and various outcomes have been reported. Purpose We sought to investigate predictors and use of VT ablation and to evaluate the post-procedural outcome in ARVC patients. Methods We studied 435 patients from the Nordic ARVC registry including 220 probands with definite ARVC according to the 2010 task force criteria and 215 mutation-carrying relatives identified through cascade screening. Patients were followed until first-time VT ablation, death, heart transplantation, or January 1st 2018. Additionally, patients undergoing VT ablation were further followed from the time of ablation for recurrent ventricular arrhythmias. Results Cumulative use of VT ablation was 4% (95% CI 3%-6%) and 11% (95% CI 8%-15%) after 1 and 10 years. All procedures were performed in probands in whom the cumulative use was 8% (95% CI 5%-12%) and 20% (95% CI 15%-26%). In adjusted analyses restricted to probands, only young age predicted need for ablation. In patients undergoing ablation, risk of recurrent arrhythmias was 59% (95% CI 44%-71%) and 74% (95% CI 59%-84%) 1 and 5 years after the procedure. Despite high recurrence rates, the burden of ventricular arrhythmias was reduced after ablation (p=0.0042). Young age, use of several antiarrhythmic drugs and inducibility to VT immediately after ablation were associated with an unfavorable outcome. Conclusions Twenty percent of ARVC probands developed a clinical indication for VT ablation within 10 years after diagnosis whereas mutation-carrying relatives were without such need. Although the burden of ventricular arrhythmias decreased after ablation, risk of recurrence was substantial.

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Surgical Treatment of Primary Cardiac Tumors—Experience with 45 Patients

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239500300205 ◽

1995 ◽

Vol 3 (2) ◽

pp. 49-52

Author(s):

Lin Jue Yi ◽

Chu Shu Hsun ◽

Lee Yuan Teh ◽

Wang Shoei Shen ◽

Lin Fang Yue ◽

...

Keyword(s):

Surgical Treatment ◽

Left Atrium ◽

Malignant Tumors ◽

Thyroid Tissue ◽

University Hospital ◽

Benign Tumors ◽

Cardiac Tumors ◽

Incomplete Resection ◽

Long Term Result ◽

Primary Cardiac Tumors

Primary cardiac tumors are very rare and the majority of them are histologically benign and surgically curable. During a 30-year period from 1963 to January 1993, 45 cases of primary cardiac tumors were surgically excised at the National Taiwan University Hospital, representing 0.52% of 8,695 open heart surgical cases during the same period. In this series, 42 cases (94%) were benign tumors; 39 (88%) were myxoma (30 female, 9 male), and 32 (82%) originated in the left atrium. None were discovered in the left ventricle. In all but the first 6 cases, tumors in patients with myxoma in the left atrium were successfully excised by the transseptal approach. There were 3 patients with rare benign tumors: intracardiac goiter, rhabdomyoma, and hemangioma respectively. The intracardiac goiter was completely excised with no ectopic thyroid tissue after operation and the other 2 received palliative resection. The latter 2 patients suffered no recurrence. Rhabdomyosarcoma, leiomyosarcoma and malignant lymphoma were noted in one patient each, all of whom died of low cardiac output in the early postoperative course. In our experience, the majority of primary cardiac tumors were benign and located in the left atrium. The long-term result of surgical treatment of benign cardiac tumors is excellent, even incases of incomplete resection, while the results from surgical treatment of malignant tumors is poor.

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Clinical classification of cardiovascular tumors and tumor-like lesions, and its incidences

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-013-0214-8 ◽

2013 ◽

Vol 61 (8) ◽

pp. 435-447 ◽

Cited By ~ 29

Author(s):

Jun Amano ◽

Jun Nakayama ◽

Yasuo Yoshimura ◽

Uichi Ikeda

Keyword(s):

Malignant Tumors ◽

Cardiac Myxoma ◽

World Health ◽

Benign Tumors ◽

Cardiac Tumors ◽

New Classification ◽

Metastatic Tumors ◽

Great Vessels ◽

Tumor Like Lesions

Abstract Tumors of the heart and the great vessels are very rare disease, and there are many disorders such as tumors originated from the heart and great vessels, metastatic tumors, and tumor-like lesions which do not fit into the usual concept of tumor or neoplasm; thus, it is very difficult to classify these tumors. We proposed a new classification of cardiovascular tumors for clinical use based on the accumulated biological analyses and clinical data of the reported literatures and our own study as benign tumors, malignant tumors, ectopic hyperplasia/ectopic tumors/others, and tumors of great vessels, with reference to the series of Atlas of tumor pathology of the Armed Forces Institute of Pathology and the recent World Health Organization classification of cardiac tumors issued in 2004. More than 50 disorders have been reported as tumors originated from the cardiovascular system, and various metastatic tumors from nearby organs, distant lesions, and intravascular extension tumors to the heart were reported. Based on the new classification, we reviewed epidemiology and incidence of cardiovascular tumors. Metastatic tumors are more frequent than tumors originated from the heart and great vessels, and cardiac myxoma is the most frequent tumors in all cardiac tumors.

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Primary Cardiac Rhabdomyosarcoma in a child -- A case report

10.22541/au.160674686.67846790/v1 ◽

2020 ◽

Author(s):

KRISHNA PRASAD MARAM ◽

Vikram Kudumula ◽

Dilip Ratti

Keyword(s):

Case Report ◽

Left Ventricle ◽

Right Ventricle ◽

Malignant Tumor ◽

Right Atrium ◽

Malignant Tumors ◽

Benign Tumors ◽

Cardiac Tumors ◽

Cardiac Rhabdomyosarcoma ◽

Primary Cardiac Tumors

Primary cardiac tumors are rare in children, usually consist of benign tumors like rhabdomyomas and fibromas that may spontaneously regress. Primary malignant tumors are extremely rare even in adults and very few paediatric cases were reported in literature. Rhabdomyosarcoma is a rare primary malignant tumor in children and most of the reported cases occur in right ventricle, left atrium and right atrium. We report a 15 month old child with primary rhabdomyosarcoma of left ventricle presenting in cardiac tamponade and circulatory failure.

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Intracardiac Masses I-Mass Study Single Center Experience Within 12 Years

10.21203/rs.3.rs-465594/v1 ◽

2021 ◽

Author(s):

Zehra Bugra ◽

Samim Emet ◽

Berrin Umman ◽

Pelin Karaca Ozer ◽

Murat Sezer ◽

...

Keyword(s):

Autoimmune Diseases ◽

Malignant Tumors ◽

Thrombus Formation ◽

Imaging Modality ◽

Benign Tumors ◽

Cardiac Tumors ◽

Cross Sectional ◽

Lung Cancers ◽

Intracardiac Masses ◽

Cardiac Masses

Abstract Objective : The aim of this cross-sectional, retrospective, descriptive study was to review and classify cardiac masses systematically and to determine their frequencies.Methods : The medical records of 64,862 consecutive patients were investigated within 12 years. Every patient with a cardiac mass imaged by transthoracic echocardiography (TTE) and confirmed with an advanced imaging modality such as transesophageal echocardiography (TEE), computed tomography (CT) and / or cardiac magnetic resonance imaging (CMR) was included. Acute coronary syndromes triggering thrombus formation, vegetations, intracardiac device and catheter related thrombi were excluded.Results : Data demonstrated 127 (0.195 %) intracardiac masses consisting of 33 (0.050 %) primary benign, 3 (0.004 %) primary malignant, 20 (0.030 %) secondary tumors, 3 (0.004 %) hydatid cysts and 68 (0.104 %) thrombi respectively. The majority of primary cardiac tumors were benign (91.67 %), predominantly myxomas (78.79 %), and the less malignant (8.33 %). Secondary cardiac tumors were common than the primary malignant tumors (20:3), with male dominancy (55 %), lymphoma and lung cancers were the most frequent. Intracardiac thrombi was the majority of the cardiac masses, thrombi accompanying malignancies were in the first range (n=17, 25%), followed by autoimmune diseases (n=13, 19.12 %) and ischemic heart disease with low ejection fraction (n=12, 17.65 %).Conclusion: This retrospective analysis identified 127 patients with cardiac masses. The majority of benign tumors were myxoma, the most common tumors that metastasized to the heart were lymphoma and lung cancers, and the thrombi associated with malignancies and autoimmune diseases were the most frequent.

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Mitral and tricuspid annulus disjunction frequently coexist

European Heart Journal ◽

10.1093/eurheartj/ehab724.0232 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Aabel ◽

M Chivulescu ◽

L A Dejgaard ◽

M Ribe ◽

E Gjertsen ◽

...

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Mitral Valve Prolapse ◽

Odds Ratio ◽

Ventricular Arrhythmias ◽

Mitral Annulus ◽

Ventricular Free Wall ◽

Free Wall ◽

Tricuspid Annulus ◽

Right Ventricular Free Wall

Abstract Background Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral annulus, frequently found in patients with high-risk arrhythmogenic mitral valve prolapse syndrome. It is unknown whether the annulus disjunction extends to the right side of the heart as tricuspid annulus disjunction (TAD), and whether it is associated with right ventricular electrical instability. Purpose We aimed to explore the presence of TAD, and if extended annulus disjunction was associated with ventricular arrhythmias. Methods We included patients with previously described MAD assessed by cardiac magnetic resonance imaging (CMR) in an ambispective cohort study. MAD and TAD was defined as ≥1 mm separation between the respective atrial wall-valve leaflet junction and the top of the ventricular myocardium. TAD was assessed in the lateral and inferior right ventricular free wall by means of the 4-chamber and right ventricular 2-chamber views, respectively. MAD circumference was assessed by a CMR study protocol with six left ventricular long axis views separated by 30 degrees. Mitral valve prolapse was defined as ≥2 mm superior displacement of any part of the mitral leaflets beyond the mitral annulus. Ventricular arrhythmias were defined as aborted cardiac arrest or non-sustained/sustained ventricular tachycardias recorded by electrocardiogram (ECG), stress ECG or Holter monitoring. Results We included 92 patients with MAD (62% female, age 47±16 years, 71% mitral valve prolapse). TAD was found in 48 (52%) patients, both in the lateral (n=40, 83%) and inferior (n=30, 63%) right ventricular free wall. Patients with TAD were older (age 51±16 years vs. 43±14 years, p=0.01), had greater MAD circumference (168±56° vs. 117±62°, p=0.001) and greater MAD distance (9.2±2.9 mm vs. 6.4±2.8 mm, p<0.001). Additionally, patients with TAD had more frequently mitral valve prolapse (40 patients [85%] vs. 25 patients [57%], p=0.003), whereas similar frequency of bileaflet prolapse (17 patients [39%] vs. 10 patients [39%], p=0.99). Ventricular arrhythmias had occurred in 38 (41%) patients, who were younger (age 40±14 years vs. 52±15 years, p<0.001) and had less frequently TAD (14 patients [37%] vs. 34 patients [63%], p=0.01; univariate odds ratio 0.34 [0.15–0.81], p=0.02). However, TAD was not associated with ventricular arrhythmias when adjusted for age (multivariate odds ratio 0.46 [0.18–1.15], p=0.10). Conclusions TAD by CMR was highly prevalent in patients with MAD and was a marker of severe annulus disjunction and mitral valve prolapse. TAD was not associated with more ventricular arrhythmias. This novel marker warrants further research to explore the clinical implications of right-sided annulus disjunction. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian Research Council

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Proarrhythmic Effect of RF ablation on the Right Ventricular Moderator Band

10.22541/au.161940160.09673667/v1 ◽

2021 ◽

Author(s):

Jonathan Willner ◽

Parth Makker ◽

Roy John

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Fibrillation ◽

Right Ventricular ◽

Ventricular Arrhythmias ◽

Conduction System ◽

Rf Ablation ◽

Moderator Band ◽

Coupling Interval ◽

The Right ◽

Durable Suppression

The right ventricular moderator band (MB) is increasingly being recognized as a source for PVCs and PVC-mediated ventricular fibrillation. Monomorphic PVCs, non-sustained monomorphic VT and ventricular fibrillation are all documented arrhythmias originating from the MB. The benign PVCs usually have a coupling interval in excess of 400 msec. When PVCs trigger VF, coupling intervals are typically short, less than 300 msec. We report here a case of long-standing frequent monomorphic PVCs with a coupling interval of > 400 msec from the right ventricular distal conduction system embedded in the moderator band that progressed to non-sustained ventricular tachycardia. Following suppression of the arrhythmia with RF ablation, the arrhythmia recurred with PVCs at a shorter coupling interval (<300 msec), with frequent repetitive non-sustained polymorphic VT and triggering of sustained ventricular fibrillation. The use of a cryoballoon to ablate over the course of the moderator band resulted in complete and durable suppression of ventricular arrhythmias.

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