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Exacerbation of symptomatic conversion pauses and episodic bradycardia: case report A 56-year-old woman experienced exacerbation of symptomatic conversion pauses and episodic bradycardia during treatment with amiodarone and metoprolol for frequent atrial fibrillation and atrial tachycardia. The woman, who had a history of hypothyroidism, was shifted to the hospital in USA from an outside facility with a 3–4 months history of progressive dyspnoea, left-sided rib pain and 30 lbs unintentional weight loss over the 6 months period. She was receiving levothyroxine sodium [levothyroxine] for hypothyroidism at that time. A right atrial filling defect was noted in the outside facility, which was initially considered as a thrombus. At admission, she was hemodynamically stable with HR 54 beats/min, BP 134/61mm Hg, oxygen saturation 98% on room air and RR 16 breaths/min. Physical examination showed point tenderness of the rib under her left breast. She had frequent paroxysms of atrial fibrillation and atrial tachycardia with ventricular rates ranging from 180–200 beats/min. These was followed by prolonged and symptomatic conversion pauses of 4–5 seconds. She also had a junctional bradycardia with rates of 30–40 seconds. Hence, she started receiving low dose amiodarone and metoprolol [dosages and routes not stated]. However, the treatment led to exacerbation of episodic bradycardia and symptomatic conversion pauses [duration of treatments to reaction onsets not stated]. Further evaluations led to the diagnosis of tachy-brady syndrome secondary to obstructing cardiac angiosarcoma. She then underwent a single chamber permanent pacemaker (PPM) implantation. The dose of her antiarrhythmic therapy was increased following the PPM implantation. Subsequently, her tachyarrhythmia episodes improved with only minimal ventricular pacing. She was also treated with neoadjuvant chemotherapy for angiosarcoma along with surgical resection with reconstruction of the right atrium and superior vena cava. Siroky GP, et al. Left Pericardiophrenic Vein Pacing for Tachy-Brady Syndrome Due to an Obstructing Cardiac Angiosarcoma. JACC: Case Reports 2: 1771-1775, No. 11, 803506725 Sep 2020. Available from: URL: http://doi.org/10.1016/j.jaccas.2020.07.013

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Reactions 10 Oct 2020 No. 1825