Secondary Cardiac Lymphoma Causing High-Grade Heart Block

Figures

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  Figure 1. Electrocardiograms Demonstrating Progression of Heart Block (A) Baseline electrocardiogram at time of initial lymphoma diagnosis demonstrating normal sinus rhythm. (B) Sinus rhythm with marked first-degree atrioventricular (AV) block. (C) Accelerated junctional rhythm with retrograde P waves. (D) Complete AV block with accelerated junctional escape rhythm (ventricular rate 60).

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  Figure 2. Cardiac Magnetic Resonance Imaging There is diffuse circumferential mass-like thickening of the left atrium and interatrial septum measuring up to 15 mm (B). Soft-tissue thickening was also seen encasing the left ventricular outflow tract and aortic root, extending to the ostia of the pulmonary veins (A and B). There was evidence of circumferential encasement of the proximal coronary arteries. In addition, there was diffuse circumferential pericardial enhancement without pericardial thickening, likely related to recent pericardial drainage (A, arrows). The left ventricular ejection fraction was calculated at 55%.

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  Figure 3. Telemetry Strip With Complete Atrioventricular Block With Junctional Escape Rhythm (Ventricular Rate 43) ECG = electrocardiogram.

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  Figure 4. Electrocardiogram at the Time of the 1-Month Device Check, Demonstrating Sinus Rhythm With Complete Heart Block and a Junctional Escape Rhythm at a Rate of 61 As the device was programmed to VVI 50, no pacing was required.

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  Visual Summary. Secondary Cardiac Lymphoma Causing High-Grade Heart Block The case demonstrates a patient with secondary cardiac lymphoma resulting in rapidly progressive atrioventricular block from (A) first-degree to (B) symptomatic complete block with junctional escape rhythm, leading to implantation of a leadless pacemaker (The arrow points to the leadless pacemaker) (C).