Elsevier

Heart Rhythm

Volume 1, Issue 3, September 2004, Pages 348-351
Heart Rhythm

Recurrent ventricular fibrillation secondary to aortic valve tumor

https://doi.org/10.1016/j.hrthm.2004.04.023Get rights and content

The case of a patient with recurrent ventricular fibrillation secondary to an aortic tumor is reported. Ventricular fibrillation occurs secondary to ischemia, arrhythmia, or congenital disease, or it may be an idiopathic event. Irreversible and recurrent situations require placement of an implantable cardioverter defibrillator (ICD). A patient with recurrent syncope secondary to documented ventricular fibrillation without a clear mechanism and a negative electrophysiologic study underwent ICD placement. A cardiac papillary fibroelastoma at the aortic valve subsequently was found. Cardiac tumors in the aortic valve can obstruct the coronary arteries, secondarily causing ischemia and ventricular fibrillation. Such a mechanism must be considered in the differential diagnosis of sudden death.

Section snippets

Case report

A 53-year-old man was referred for evaluation of recurrent convulsive syncopal episodes. The episodes had started 2 months earlier, always occurred at rest, were preceded by chest and back discomfort, and were followed by syncope and seizures. After the seizures, the patient recovered consciousness but developed sustained hypotension that lasted for several hours. He gradually recovered without sequelae. The ECG recorded during one of these episodes showed progressive widening of the QRS in all

Discussion

Cardiac papillary fibroelastomas are the second most common primary cardiac tumor. They are benign endocardial papillomas that predominantly affect the cardiac valves, accounting for three fourths of all cardiac valve tumors.4 The aortic valve is most commonly affected, followed by the mitral valve.7, 8 Cardiac papillary fibroelastomas occur slightly more frequently in men (55%), with the highest prevalence in the eighth decade of life. The patient reported here was a 53-year-old man. Cardiac

Conclusion

Primary cardiac tumors in the aortic valve can cause ischemia and VF. The diagnosis can be difficult, and these tumors should always be considered in the differential diagnosis of sudden death.

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