Abstract 9262: The Clinical and Electrophysiologic Manifestations of Cardiac Tumors: A Single-Center Retrospective Study

Abstract

Introduction: Cardiac tumors are rare and their effect on the cardiac conduction system is not well-described. Currently there is no recommendation for routine arrhythmia screening in this population. This study aimed to characterize the clinical presentation and electrophysiologic manifestations of patients with cardiac tumors. Methods: A radiologic database from a four-hospital health system was queried to identify patients with a cardiac tumor diagnosed on CMR from 2003-2021. The electronic health record, ECGs, arrhythmia monitors, echocardiograms and CMRs were reviewed for each patient. Results: Forty-nine patients were identified with intra-cardiac or pericardial tumors. The cohort had a mean age of 57.3 ±14.6 years old and was 53% female. Cardiovascular risk factors were prevalent: HTN (59%), HLD (43%), DM (26%), CAD (20%). Common presenting symptoms were SOB (30.6%), palpitations (24.5%) and chest pain (20.4%); many patients had no overt cardiac symptom (42.9%). By CMR, tumors were classified as pericardial (44.9%) vs myocardial (55.1%), primary tumor (57.1%) vs secondary tumor (42.9%) and located nearest the atrium (24.5%), ventricle (55.1%) or both (14.3%). Twenty-three patients (47%) had tumors that were labeled as malignant, with the most common diagnoses being diffuse large B-cell lymphoma (DLBCL, 10.2%), non-small cell lung cancer (8.2%) and melanoma (6.1%). Non-trivial pericardial effusions were common (24.5%), with one case complicated by tamponade. Seven patients (14.2%) were documented to have cardiac arrhythmias including one patient with sudden arrhythmic death (SAD). Neither pericardial effusion (OR 3.7, CI 0.5-29.6) nor atrial tumor location (OR 2.8, CI 0.4-21.8) was predictive of atrial fibrillation or SVT. Ventricular arrhythmias were observed in patients with ventricular tumors (11.8%), but not atrial tumors (0%). Sustained VT was found in two patients with invasive DLBCL. Conclusion: Cardiac tumors are associated with frequent cardiac symptoms, pericardial effusions and cardiac arrhythmia. Sustained VT was documented in two patients with DLBCL in the ventricle, one of whom experienced SAD. Prospective studies employing long-term rhythm monitoring may be warranted to inform the need for arrhythmia screening.