Key result
Intracardiac Pancoast tumor metastases cause hyperacute ST-elevation and AV block followed by rapid post-pacemaker death.
Why the study?
Cardiac metastases commonly present with pericardial effusion, valvular dysfunction, or conduction disturbances, but 2:1 atrioventricular block secondary to cardiac metastasis is rare.
Case Report (n=1)
Cardiac metastases from a Pancoast tumour can rarely present with 2:1 AV block and ST-segment elevation, highlighting the need for multimodality imaging and careful consideration of palliative pacing.
AV block may prompt metastasis evaluation in cancer patients; this case leaves open questions on prevalence and management.
Background Cardiac metastases are significantly more common than primary cardiac tumours. Their clinical presentation varies depending on tumour size, location, and degree of myocardial or pericardial infiltration. Common manifestations include pericardial effusion, valvular dysfunction due to inflow or outflow obstruction, and conduction disturbances. 2:1 atrioventricular (AV) block secondary to cardiac metastases is rare. Case Summary We report a case of a 69-year-old man with a Pancoast tumour who presented with hyperacute ST-segment elevation and 2:1 AV block. Transthoracic echocardiography (TTE) and positron emission tomography (PET) revealed intracardiac metastases. A permanent dual-chamber pacemaker was implanted for symptomatic 2:1 AV block. The patient died from advanced malignancy shortly after device implantation. Discussion This case highlights 2:1 AV block as an uncommon manifestation of cardiac metastases. Multimodality imaging particularly TTE, cardiac magnetic resonance imaging, and cardiac PET play a pivotal role in timely diagnosis. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. Decisions regarding permanent pacing should be shared between the patient and clinicians, incorporating balance between clinical indications, patient’s comorbidities, prognosis, and preferences.
No takes yet. Share an insight, caveat, or question.
Fang et al. (2026) conducted a case report in Cardiac metastasis from a Pancoast tumour (n=1). Permanent dual-chamber pacemaker implantation was evaluated. A 69-year-old man with a Pancoast tumour presented with hyperacute ST-segment elevation and 2:1 AV block due to intracardiac metastases, and died shortly after permanent pacemaker implantation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: