Epicardial pacemaker implantation for sick sinus syndrome in a patient with supra vena cava obstructed by a primary cardiac lymphoma

Abstract

Primary cardiac lymphoma (PCL) involves the heart and pericardium. Symptoms may vary according to the cardiac site involved. The most frequent cardiac manifestations associated with PCL are pericardial effusion, heart failure, and atrioventricular block. PCL can be diagnosed using transesophageal echocardiography, computed tomography (CT), or magnetic resonance imaging. We herein discuss a 67-year-old male patient who presented with sick sinus syndrome. CT demonstrated a tumor in the right atrium obstructing the superior vena cava. The patient underwent a diagnostic lateral thoracotomy with concomitant epicardial pacemaker insertion. Histological examination revealed a diffuse large B cell lymphoma, and chemotherapy, including rituximab, was begun. A diagnostic thoracotomy is crucial for a definitive diagnosis of PCL, and the most effective treatment is chemotherapy. <Learning objective: Primary cardiac lymphoma may cause sick sinus syndrome. The choice of epicardial lead precludes the risk of peripheral embolisms during transvenous endocardial pacemaker insertion.>.

Keywords: Epicardial lead; Epicardial pacemaker; Primary cardiac lymphoma; Sick sinus syndrome.