Abstract 16092: Oncology Meets Cardiology: Sustained Ventricular Tachycardia With a Pulse

Abstract

Introduction: Palpitations are one of the most common presenting symptoms. While usually benign, they can be life-threatening. We present a case of a sustained VT in the setting of a rare transformation of Follicular Lymphoma (FL). Case Description: An 86-year-old female with a history of FL with cardiac involvement, hypothyroidism, and hypertension presented with three episodes of palpitations. The first lasted about 20 minutes and spontaneously resolved. The second occurred a few hours later and was resolved within 15 minutes. Her third did not resolve. On presentation, she was complaining of palpitations and lightheadedness. BP 136/97, HR 193. Physical exam revealed no respiratory distress, rapid rate, clear lung fields, and unremarkable neurological exam with clear mentation. ECG (below) demonstrated sustained VT with rates of ~260 bpm. Amiodarone bolus was started. Cardioversion was attempted, but her VT degenerated into Ventricular Fibrillation. She achieved ROSC and was admitted with sinus rhythm. It was suspected that her FL had transformed into a more aggressive lymphoma, i.e. Diffuse Large B cell Lymphoma (DLBCL). On Cardiac MRI, she had metastasis to the right AV groove consistent with cardiac lymphoma, which was the etiology of her arrhythmia. She elected to enroll in hospice and was discharged in sinus rhythm. Impact/Discussion: Histological transformation (HT) of indolent non-Hodgkin lymphoma subtypes (FL) to clinically aggressive subtypes (DLBCL) is estimated to occur 1-2 %/year. Although there have been studies examining risk factors suggestive of HT, much still needs to be studied to effectively manage patients with cardiac metastasis. In this case, metastasis involved the right AV groove, which was the cause of her arrhythmia. Patients with sustained VT usually present with severe symptoms including cardiac arrest, but can present with mild symptoms, as was the case of this patient. Prompt evaluation and management of palpitations is paramount.