Third Degree Atrio-Ventricular-Block Caused by Malignant Non-Hodgkin's Lymphoma: An Unusual Indication for Epicardial Pacing

A 59-year old female patient presented with progressive dyspnoea, intermittent fever and third-degree atrio-ventricular-block. On echocardiography she had nodular deposits on the lateral wall of the left and in the entire right atrium. A computed tomography scan demonstrated extensive retrocardial tumour masses infiltrating both atria and the interatrial septum. The patient underwent a diagnostic lateral thoracotomy with concomitant epicardial pacemaker insertion. Histological examination revealed a centroblastic B-cell-lymphoma. The management of this patient is discussed and the literature reviewed.