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Giant Fibroma with Ventricular Tachycardia in an Elderly Patient

A 78-year-old woman was admitted to our hospital because of wide complex tachycardia. Twelve-lead ECG showed a negative T wave in the inferior and precordial leads. Holter ECG showed nonsustained ventricular tachycardia at a rate of 140 beats/min (Fig. left) without palpitation. The QRS morphology was left bundle branch block with a superior axis, suggesting it originated from the lower part of the right ventricle (RV). Echocardiography revealed a large mass at the lower part of the RV and septum. Multislice helical computed tomography (CT) scan was performed with retrospective ECG gating. Diastolic images showing inferior vena cava (IVC), right atrium (RA), right coronary artery (RCA) and RV were obtained with 2-mm thick sections, and three-dimensional images were reconstructed by volume rendering. CT scan revealed the presence of a giant mass, 9.0 5.0 cm, in the lower part of the heart in ltrated into the myocardium, extending from the lower septum to both ventricles (Fig. left, arrow). The mass was slightly enhanced by contrast medium and included calci ed lesion. Endomyocardial biopsy revealed reduced cellularity of the tumor and increased collagen content with elastic  bers. Fibrous tissue was intermingled with myocardial  bers at the margin of the lesion (Fig. right: A: 40 , B: 200 , hematoxylin-eosin stain; C: 100 , Masson trichrome stain). These pathologic  ndings were compatible with cardiac  broma. Programmed electrical stimulation failed to induce ventricular tachycardia, even with isoproterenol infusion. The patient was given oral atenolol 50 mg/day, and no recurrence was observed in repeat Holter ECG over a 12-month follow-up period. J Cardiovasc Electrophysiol, Vol. 13, p. 730, July 2002.