Key result
Surgical resection of large intramyocardial fibroma eliminates recurrent VT and preserves LVEF at 6 months.
Why the study?
Cardiac fibromas are extremely rare in adults, and determining whether surgical resection is feasible over antiarrhythmic medication or heart transplantation depends on imaging characterization of tumor extent and involvement of critical cardiac structures.
Does surgical resection prevent recurrence of ventricular arrhythmias in an adult patient with an intramyocardial fibroma presenting with ventricular tachycardia?
Case Report (n=1)
No
Does surgical resection prevent recurrence of ventricular arrhythmias in an adult patient with an intramyocardial fibroma presenting with ventricular tachycardia?
This case demonstrates that complete surgical resection of a large intramyocardial fibroma in an adult presenting with refractory ventricular tachycardia is feasible and can eliminate arrhythmias while preserving ventricular function without requiring an ICD.
Surgical resection may eliminate VT without ICD in adult intramyocardial fibroma; leaves open generalizability beyond this single case.
BACKGROUND: Cardiac fibromas are extremely rare in adults. The preferred treatment is surgical resection, but antiarrhythmic medications or heart transplantation have also been used previously. The cardiac imaging, particularly MRI, can be useful to help delineate between primary cardiac tumors, and surgical factors such as the extent/size of the fibroma, involvement of the coronary arteries or mitral apparatus and amount of residual myocardium influence whether surgical resection is feasible. CASE PRESENTATION: A 42-year-old male presented with a wide-complex tachycardia, unresponsive to amiodarone. An echocardiogram was performed which showed a possible posterior wall mass. A cardiac MRI showed a well circumscribed lateral wall intracardiac fibroma, measuring 5.2 × 5.1 × 3.8 cm with preserved function. Surgical resection was successful, and he was discharged without a defibrillator. CONCLUSIONS: Cardiac fibromas are encapsulated tumors which do not infiltrate myocardium and should be surgically resected if possible.
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Roby et al. (2024) conducted a case report in Ventricular tachycardia caused by a left ventricular intramyocardial fibroma (n=1). Surgical resection of intramyocardial fibroma was evaluated on Recurrence of sustained ventricular arrhythmias and post-operative left ventricular ejection fraction at 6 months. Surgical resection of a 5.2 x 5.1 x 3.8 cm intramyocardial fibroma eliminated ventricular tachycardia recurrences and preserved ejection fraction (56%) at 6-month follow-up.
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