Large Right Atrial Myxoma after Transcatheter Ablation

Objectives: The growth of an atrial myxoma related to a previous radiofrequency catheter ablation (RFA) has been rarely reported. It has been demonstrated through biopsy studies that catheter RFA causes endocardial thickening and fibrous scars to the endocardial tissue which instigate reorganization of local cells. Other studies have related the growth of myxoma with cardiac trauma like the trans-septal puncture used to access the left atrium.

Methods: We describe the case of a 35-year-old woman admitted for evaluation of a left-sided chest pain with radiation to the left arm over 48 hours. The pain would increase by sneezing and blood tests showed leukocytosis. Relevant past medical history include a transcatheter atrial ablation for atrioventricular nodal reentrant tachycardia (AVNRT) performed 18-months earlier. The transthoracic echocardiogram by admission revealed a large (35 × 30 × 53 mm) lobulated mass attached to the right atrial septum that protruded through the tricuspid valve into the right ventricle during diastole.

Results: Surgical resection of the tumor was performed one day later. After the opening of the right atrium, a large myxoma was removed including the adjacent part of the interatrial septum. The resultant septal defect was closed by a bovine pericardial patch. Histopathological examination confirmed the echocardiographic suspicion of a non-malign right atrial myxoma. Postoperative echocardiography did neither show any residual atrial septum defect nor a significant tricuspid regurgitation. The patient was discharged seven days after surgery in good condition.

Conclusions: Based on actual data it is still uncertain whether a cardiac trauma such as radiofrequency energy or transseptal puncturing, may induce the growth of an atrial myxoma. A spontaneous and rapid growth (2–3 mm/month) of a large myxoma after RFA in this short post procedural period should not be ruled out. In any case a 6-month follow-up echocardiography should be recommended for patients undergoing catheter ablation procedure.