Alleviation of carotid sinus syncope and removal of cardiac pacing after regression of cervical malignant lymphoma

• Published in: Rinshō ketsueki Vol. 54; no. 1; p. 117
• Main Authors: Mashima, Yukinori, Kawakami, Manabu, Hasegawa, Koji, Takemoto, Masako, Hamada, Hidefumi, Ishikawa, Jun, Nakagawa, Masashi
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.01.2013
• Subjects: Aged; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antineoplastic Agents - therapeutic use; Cardiac Pacing, Artificial - methods; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - drug therapy; Humans; Lymphoma, B-Cell - complications; Lymphoma, B-Cell - diagnosis; Lymphoma, B-Cell - drug therapy; Magnetic Resonance Imaging - methods; Male; Rituximab; Syncope - diagnosis; Syncope - drug therapy; Syncope - etiology
• ISSN: 0485-1439
• DOI: 10.11406/rinketsu.54.117

A 68-year-old man developed a rapidly-growing right cervical tumor, a biopsy of which allowed for the diagnosis of diffuse large B-cell lymphoma, not otherwise specified. Magnetic resonance imaging demonstrated a right cervical mass lesion of 80 mm in diameter that extended from the medial region of the parotid gland to the posterior region of the neck. While undergoing a chest X-ray in an upright position, he lost consciousness and briefly fell. A transient loss of consciousness recurred while changing his position on the bed, and an electrocardiogram at that time revealed sinus arrest of a seven second duration. This syncope was considered to be a carotid sinus syncope (CSS) induced by the compression of the carotid sinus by his cervical bulky lymphoma. Temporary cardiac pacing was immediately started and rituximab was administered. Three days later, CHOP therapy was started. As his cervical tumor rapidly shrank, the frequency of sensed sinus arrests decreased to zero per day by day 9 of CHOP therapy, resulting into the removal of the pacemaker. In certain cases with CSS due to cervical lymphoma, cardiac pacing, if needed at the onset, is considered to become removable early after chemotherapy in association with tumor shrinkage.