CONGRESS ABSTRACT

New chemotherapy agents and radiotherapy have improved mortality and survival of patients with neoplastic diseases; however, such therapies can cause significant side effects. One of the main concerns about mediastinal radiotherapy is the occurrence of cardiovascular side effects a long time after the treatment. This is an important issue – especially for thoracic neoplasms with long term survival, such as Hodgkin ‘s lymphoma- because of the increase in cardiovascular morbidity and mortality. We report the case of a 40 years old male with infra-Hisian atrioventricular block developed progressively about twenty years after receiving radiotherapy for Hodgkin lymphoma. The patient experienced episodes during effort of abrupt and sudden reduction of the cardiac frequency and a syncope due to effort with finding of remarkable bradycardia. He was subsequently admitted for asthenia, dyspnea due to mild-moderate effort and bradycardia found at the self monitoring. The electrocardiogram showed atrioventricular block 2:1 with right branch block and left anterior fascicular block. Heart rate monitoring after the admission showed almost persistent 2:1 AV block. We performed a transthoracic echocardiography showing valvular thickening attributed to former radiotherapy in the absence of any clinical history of interest. A RMC was performed and it excluded the presence of edema or pathologic late gadolinium enhancement. We performed an electrophysiologic study that showed impairment of the infra-Hisian conduction system. With continuous atrial stimulation with RR cycle 620 me we documented infrahisian Wenckebach point. Therefore, a dual chamber pacemaker was implanted. This case rase the need for new studies evaluating the incidente of radiation induced heart disease. Clinicians must pay attention to bradyarrhythmia-related symptoms in patients whit previous exposure to chest radiation because of possibile premature onset of conduction disturbances.