RECURRENT SUPRAVENTRICULAR ARRHYTHMIA: WHEN ABLATION IS NOT THE ANSWER – A PERPLEXING CASE OF PHENOCHROMOCYTOMA
Gorgis S, Dabbagh M, Mawri S, Akoegbe G, Alanee S, Alaswad K, Dabaja A, and Rabbani B. RECURRENT SUPRAVENTRICULAR ARRHYTHMIA: WHEN ABLATION IS NOT THE ANSWER – A PERPLEXING CASE OF PHENOCHROMOCYTOMA. J Am Coll Cardiol 2019; 73(9):2941.
J Am Coll Cardiol
Background: Hormone-secreting tumors can cause subtle symptomatic arrhythmias that are difficult to diagnose. Early suspicion of such tumors can lead to appropriate diagnosis, treatment, and reduction of unnecessary procedures. Case: A 41-year-old male with a history of hypertension and anxiety presented to the hospital over twenty times with recurrent episodes of atypical chest pain, palpitations, dizziness, and dyspnea. Electrocardiogram revealed supraventricular tachycardia. Electrophysiology study showed typical counterclockwise, cavo-tricuspid isthmus-dependent, right atrial flutter which was reproducibly induced with burst atrial pacing. There were also brief episodes of atrial fibrillation. He underwent successful ablation of the cavo-tricuspid isthmus with confirmed bi-direction block, and was placed on warfarin. However, his symptoms recurred. An episode of NSTEMI led to left heart catheterization, which showed clean coronaries. He developed hematuria on anticoagulation and underwent abdominal imaging which revealed a 2.7cm left adrenal mass. Laboratory tests were consistent with pheochromocytoma. Decision-making: The patient's beta blocker was reduced, and an alpha blocker was started. He underwent successful robot-assisted adrenalectomy with symptomatic improvement. An event monitor revealed no evidence of atrial fibrillation for 28 days. He returned to work without any complaints of recurrent symptoms. Conclusion: Pheochromocytomas are a life-threatening cause of supraventricular arrhythmias. Late recognition results in delays in diagnosis, unnecessary procedures, and poor patient outcomes. Timely recognition and resection of such tumors can result in resolution of arrhythmias.
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