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Secondary Cardiac Lymphoma Causing High-Grade Heart Block: Pacemaker Considerations in an Unpredictable Clinical
John Sollee1, Graham Peigh2, Kaustubha Patil2
1Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Insights
Cardiac lymphoma can cause heart block, complicating pacemaker decisions. Individualized management considering treatment response and patient preferences is crucial for optimal outcomes in these complex cases.
Area of Science:
- Cardiology
- Oncology
- Electrophysiology
Background:
- Cardiac lymphoma can infiltrate the heart's conduction system.
- This infiltration may lead to rapidly progressive high-grade atrioventricular block.
- Conduction abnormalities can potentially improve with lymphoma treatment, complicating pacemaker decisions.
Background:
Cardiac lymphoma can cause rapidly progressive high-grade atrioventricular block by infiltrating the conduction system. Because conduction disease may improve with lymphoma-directed therapy, pacemaker decisions are complex.
Case Summary:
A 44-year-old man with lymphoma developed extensive secondary cardiac involvement and progressive conduction system disease. Given the possibility of reversibility with immunotherapy, multidisciplinary discussions and shared decision-making were used to determine whether pacemaker implantation was warranted and to select the most appropriate device. An active-fixation leadless pacemaker was ultimately implanted.
Discussion:
This case highlights the uncertainty regarding pacemaker management in cardiac lymphoma. Decisions should be individualized based on expected treatment response, infection risk, and patient preferences.
Take-Home Messages:
Cardiac lymphoma may present with rapidly progressive conduction disease, and the degree of reversibility following lymphoma-directed therapy can be difficult to predict. Decisions regarding pacemaker implantation should be individualized and informed by the expected treatment response, infectious and procedural risks, and patient preferences.
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