Key result
A 24-year-old man with tongue cancer presenting with complete heart block due to cardiac metastasis was managed with a temporary pacemaker, but died 20 days later from respiratory failure and septic shock.
Why the study?
Cardiac metastasis presenting with complete heart block is extremely uncommon, and there are no guidelines on managing complete heart block in terminal cancer.
Case Report (n=1)
No
Complete heart block is a rare manifestation of cardiac metastasis from oral cancer, and permanent pacemaker implantation should be carefully weighed against the patient's poor prognosis and comorbidities.
Rapid mortality after cardiac metastasis symptoms in oral cancer cautions device decisions; leaves open optimal management in advanced malignancy.
Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. A intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient's functional status, comorbid diseases, prognosis, and response to conservative management.
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Andrianto et al. (2020) conducted a case report in Complete heart block secondary to cardiac metastasis of oral cancer (n=1). Temporary pacemaker implantation and pericardiocentesis was evaluated on Clinical outcome. A 24-year-old man with tongue cancer presenting with complete heart block due to cardiac metastasis was managed with a temporary pacemaker, but died 20 days later from respiratory failure and septic shock.
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