Ventricular tachycardia as the presenting feature in two patients with cardiac lipoma and cardiac fibroma

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Ventricular tachycardia secondary to benign intramural cardiac tumours (cardiac lipoma and cardiac fibroma) (n=2). Intervention: Amiodarone and metoprolol. Primary outcome: Ventricular tachycardia recurrence.

Q: What does this research mean for the field?

Medical therapy with amiodarone and metoprolol can provide long-term suppression of ventricular tachycardia in patients with inoperable intramural cardiac lipoma and fibroma. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Vadivelu Ramalingam; Shomu Bohora; Neeta Bachani; Rajeev Sharma; Gopi Krishna Panicker; Yash Lokhandwala

doi:10.1016/j.ipej.2020.10.001

October 14, 2020Indian Pacing and Electrophysiology JournalOpen Access

Ventricular tachycardia as the presenting feature in two patients with cardiac lipoma and cardiac fibroma

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Key Points

To describe the clinical presentation, multimodality imaging diagnosis, and management of two patients with benign intramural cardiac tumors presenting with ventricular tachycardia.
Evaluated two patients presenting with hemodynamically unstable ventricular tachycardia using echocardiography, cardiac CT, and cardiac MRI.
Managed both patients conservatively with antiarrhythmic medical therapy consisting of amiodarone and metoprolol after surgical resection was deemed unfeasible due to extensive myocardial infiltration.
A 21-year-old man presented with unstable monomorphic ventricular tachycardia at 180 beats per minute, was diagnosed with a 4.8 × 7.2 × 1.4 cm cardiac lipoma, and remained asymptomatic at 3 years on medical therapy except for one recurrence after medication cessation.
A 47-year-old man presented with unstable ventricular tachycardia at 200 beats per minute, was diagnosed with a 4.6 × 3.5 cm left ventricular intramural fibroma, and had no arrhythmia recurrences at 5 years of follow-up.

Study Design

Type

Case Report (n=2)

Structured PICO

P

Population

2 adult men (aged 21 and 47 years) presenting with hemodynamically unstable ventricular tachycardia caused by inoperable intramural cardiac lipoma and fibroma, followed for 3 to 5 years on medical therapy.

I

Intervention

Multimodality imaging and medical therapy

Limitations

Endomyocardial biopsy was not performed due to safety concerns
Surgical excision was not feasible due to extensive myocardial infiltration
Both patients refused implantable cardioverter-defibrillator placement

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Implication

Multimodality imaging is crucial for diagnosing intramural benign cardiac tumors presenting as ventricular tachycardia when echocardiography is insufficient and biopsy is unsafe.

Abstract

We hereby present two patients with benign cardiac tumours presenting as ventricular tachycardia (VT). Most such tumours have a favorable prognosis, unless complicated by arrhythmias. Intracavitary tumours are easily diagnosed by echocardiography. Intramural tumours as in our patients may be missed at times by echocardiography. Multimodality imaging helped confirm the diagnosis and etiology, since biopsy was not safe. Surgical removal was not feasible due to extensive infiltration. The patients are so far doing well on medical therapy.

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Cite This Study

Ramalingam et al. (2020) conducted a case report in Ventricular tachycardia secondary to benign intramural cardiac tumours (cardiac lipoma and cardiac fibroma) (n=2). Amiodarone and metoprolol was evaluated on Ventricular tachycardia recurrence.

synapsesocial.com/papers/6a82d7aefdcaa17bff6d120b https://doi.org/10.1016/j.ipej.2020.10.001

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Ventricular tachycardia as the presenting feature in two patients with cardiac lipoma and cardiac fibroma

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Ventricular tachycardia as the presenting feature in two patients with cardiac lipoma and cardiac fibroma

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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