Woman with primary cardiac lymphoma and refractory ventricular tachycardias

History: A 65-year-old woman had suffered from relapsing ventricular tachyc ardias (VT) since 1996. Findings: Physical examination was normal. An arrhythmogenic substrate was found in the right ventricular outflow tract by electrophysiological examin ation. Nuclear magnetic resonance imaging (MRI) showed an infiltration of t he right heart. Myocardial biopsy revealed a high-grade centroblastic non H odgkin lymphoma. The patient was now transferred to our hospital for furthe r treatment. Lactate dehydrogenase was elevated (2,030 U/I). Echocardiograp hy showed a thickened and more reflecting right ventricular myocardium. Bon e marrow aspiration and MRI/computed tomography of abdomen and thorax exclu ded a generalized stage. Ventricular tachycardias were caused by a primary cardiac lymphoma. Treatment and Course: Combined radio-chemotherapy succeeded in complete rem ission. High-frequency ablation and amiodarone failed. Although MRI showed no more vital lymphoma after the combined radio-chemotherapy the patient su ffered from spontaneous and symptomatic relapses of VT. Therefore this pati ent with primary cardiac lymphoma was the first in literature to get a defi brillator (ICD). The incidence of VT decreased and up to now the patient sh owed no relapse of the non Hodgkin lymphoma (follow-up 23 months).