Arrhythmic risk in ventricular cardiac tumors: A comparative imaging and clinical analysis.
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BACKGROUND: Ventricular arrhythmias and sudden cardiac death (SCD) are serious complications of cardiac tumors, but predictors of arrhythmic risk in patients with ventricular masses remain poorly defined. OBJECTIVE: To identify clinical, anatomical, and imaging features associated with ventricular arrhythmia/SCD (VA/SCD) presentation in patients with ventricular cardiac masses. METHODS: We performed a retrospective comparative cohort study using a prospectively maintained registry at Aswan Heart Centre including patients with ventricular cardiac masses (2012-2024). Patients with sustained ventricular tachyarrhythmia, survived sudden cardiac arrest, or arrhythmic death were classified as the VA/SCD group and compared with patients without significant ventricular arrhythmia. Continuous variables were compared using Mann-Whitney U test and categorical variables using Fisher's exact test. RESULTS: Among 34 patients, 11 (32.4%) had VA/SCD presentation during a median follow-up of 3 years. The VA/SCD group was older (14 vs. 1 year, p = 0.044) and more frequently presented with syncope (45.5% vs. 0%, p = 0.002) and palpitations (63.6% vs. 21.7%, p = 0.026). Tumors were larger (6.8 vs. 2.3 cm, p < 0.001) and exclusively solitary (100% vs. 60.9%, p = 0.017). Fibromas and vascular tumors were more frequent, whereas rhabdomyomas were confined to the non-arrhythmic group (p = 0.002). Late gadolinium enhancement was numerically higher in the VA/SCD group (90.9% vs. 57.9%, p = 0.100). Ventricular function and hemodynamic parameters were similar between groups. CONCLUSIONS: VA/SCD presentation in ventricular cardiac masses is associated with a phenotype of larger size, solitary morphology, and arrhythmogenic histology rather than impaired ventricular function. But these patterns were confounded by tumor type, especially pediatric multifocal rhabdomyomas.