Arrhythmic risk in ventricular cardiac tumors: A comparative imaging and clinical analysis

Ventricular arrhythmias and sudden cardiac death (SCD) are serious complications of cardiac tumors, but predictors of arrhythmic risk in patients with ventricular masses remain poorly defined.

To identify clinical, anatomical, and imaging features associated with ventricular arrhythmia/SCD (VA/SCD) presentation in patients with ventricular cardiac masses.

We performed a retrospective comparative cohort study using a prospectively maintained registry at Aswan Heart Centre including patients with ventricular cardiac masses (2012-2024). Patients with sustained ventricular tachyarrhythmia, survived sudden cardiac arrest, or arrhythmic death were classified as the VA/SCD group and compared with patients without significant ventricular arrhythmia. Continuous variables were compared using Mann-Whitney U test and categorical variables using Fisher's exact test.

Among 34 patients, 11 (32.4%) had VA/SCD presentation during a median follow-up of 3 years. The VA/SCD group was older (14 vs. 1 year, p = 0.044) and more frequently presented with syncope (45.5% vs. 0%, p = 0.002) and palpitations (63.6% vs. 21.7%, p = 0.026). Tumors were larger (6.8 vs. 2.3 cm, p < 0.001) and exclusively solitary (100% vs. 60.9%, p = 0.017). Fibromas and vascular tumors were more frequent, whereas rhabdomyomas were confined to the non-arrhythmic group (p = 0.002). Late gadolinium enhancement was numerically higher in the VA/SCD group (90.9% vs. 57.9%, p = 0.100). Ventricular function and hemodynamic parameters were similar between groups.

VA/SCD presentation in ventricular cardiac masses is associated with a phenotype of larger size, solitary morphology, and arrhythmogenic histology rather than impaired ventricular function. But these patterns were confounded by tumor type, especially pediatric multifocal rhabdomyomas.