Case report
A 70-year-old man affected by a metastatic lung adenocarcinoma developed a third degree atrioventricular block symptomatic for syncope.
The diagnosis of pulmonary neoplasia was previously made following the appearance of superior vena cava syndrome, causing oedema of the submandibular and supraclavicular regions of the neck and the upper limbs. The chest computed axial tomography revealed an extensive thrombosis of the upper central veins involving the superior vena cava, subclavian veins, jugular veins and the brachiocephalic vein, with multiple enlarged lymph nodes in the mediastinum and the axillary area bilaterally.
The patient started multiple courses of radiotherapy, chemotherapy and immunotherapy.
A year after the cancer diagnosis, the patient developed complete atrioventricular block symptomatic for syncope with class I indication to permanent pacing. At that time the lung cancer was even more locally advanced: there was an extensive mediastinal adenopathy with a chronic thrombosis of the superior vena cava invading the right atrium (figure 1 and 2) and precluding insertion of a traditional standard leads based pacemaker.