A Case of Sustained Ventricular Tachycardia Secondary to a Cardiac Fibroma in a Patient With Gorlin Syndrome

Cardiac fibromas are a rare but important cause of ventricular tachycardia. They are known to be more arrhythmogenic than other cardiac tumors, which require definitive management with excision of the mass to reduce the risk of recurrent arrhythmias and sudden cardiac death. We present a case of a 21-year-old male with Gorlin syndrome and cardiac fibroma presenting with chest discomfort and shortness of breath. His electrocardiogram (ECG) showed stable sustained ventricular tachycardia, initially resistant to intravenous (IV) amiodarone; however, the patient subsequently converted to normal sinus rhythm after the administration of IV metoprolol. The patient underwent imaging investigations, including an echocardiogram and computed tomography (CT) coronary angiogram. These imaging modalities showed a solid mass measuring 7.2 x6.3 x 5.8 cm in the superior aspect of the heart. It involved the anterior wall of the left and right ventricles along the mid and basal segments with extension into the interventricular septum. The coronary arteries had no luminal irregularities and normal anatomical positions. After consultation with his cardiologist, the patient was offered the placement of an automated implantable cardioverter defibrillator; however, he declined to have it placed. He ultimately agreed to pharmacological management, and he was discharged on low-dose metoprolol.