Infant Cardiac Rhabdomyoma With Incessant Arrhythmia: Role of Tumor Debulking and Margin Cryoablation

Area of Science:

• Pediatric Cardiology
• Cardiac Surgery
• Oncology

Background:

• Cardiac rhabdomyomas are benign tumors associated with tuberous sclerosis.
• Atrial arrhythmias can complicate rhabdomyoma management, leading to significant morbidity.
• Current treatments often focus on medical management, with limited success in refractory cases.

Observation:

• A 4-month-old infant presented with drug-refractory atrial arrhythmias secondary to cardiac rhabdomyomas.
• Despite maximal medical therapy and extracorporeal membrane oxygenation, arrhythmias persisted.
• Surgical intervention was required to address the underlying tumor burden.

Findings:

• Surgical debulking of the atrial rhabdomyoma was performed under cardiopulmonary bypass.
• A residual tumor rim on the right atrial free wall was treated with cryoablation.
• The patient was successfully weaned off antiarrhythmic medications and extracorporeal support.

Implications:

• This case demonstrates the feasibility and efficacy of surgical tumor resection combined with cryoablation for managing refractory atrial arrhythmias in infants with cardiac rhabdomyomas.
• Targeted surgical intervention offers a potential curative approach for this challenging clinical scenario.
• Long-term follow-up confirmed sustained arrhythmia freedom, highlighting the durable benefits of this combined therapeutic strategy.