B-cell lymphoma of the pericardium presenting with ventricular tachycardia with a successful catheter ablation Takumi Yamada, MD, Franjo Siric, MD, Vishnu.

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B-cell lymphoma of the pericardium presenting with ventricular tachycardia with a successful catheter ablation Takumi Yamada, MD, Franjo Siric, MD, Vishnu V.B. Reddy, MD, G. Neal Kay, MD HeartRhythm Case Reports Volume 2, Issue 5, Pages 384-387 (September 2016) DOI: 10.1016/j.hrcr.2016.05.002 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Cardiac tracings exhibiting entrainment pacing (left panel), an activation map (right upper panel) during the ventricular tachycardia (VT), and a fluoroscopic image exhibiting a failed pericardial access (right lower panel). The red tags in the activation map indicate the endocardial ablation sites. In the fluoroscopic image, the ablation catheter was positioned on the endocardial surface in the right ventricle. Note that the contrast was injected through the path of the needle into the right ventricle, suggesting the presence of a pericardial adhesion. ABL = ablation catheter; CS = coronary sinus; CS 1 to 5 = the first (most distal) to fifth (most proximal) electrode pairs of the CS catheter; HB = His bundle; INF = inferior; LV = left ventricle; RAO = right anterior oblique projection; RV = right ventricle; d, p = the distal and proximal electrode pairs of the relevant catheter. HeartRhythm Case Reports 2016 2, 384-387DOI: (10.1016/j.hrcr.2016.05.002) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Voltage maps exhibiting an extensive epicardial scar and ablation sites in the right ventricle (left panel), cardiac tracings exhibiting an isolated diastolic potential (arrowhead) recorded on the epicardial surface (middle panel), and fluoroscopic images exhibiting the epicardial ablation site (right panels). The red tags indicate the ablation sites with isolated diastolic potentials. LAO = left anterior oblique projection; RCA = right coronary artery; RVOT = right ventricular outflow tract; TA = tricuspid annulus. Other abbreviations as in Figure 1. HeartRhythm Case Reports 2016 2, 384-387DOI: (10.1016/j.hrcr.2016.05.002) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Histologic section of the pericardial specimen. (A) Low-power image showing diffuse lymphomatous infiltrates with fibrosis. (B) Higher magnification demonstrates large lymphoma cells in a fibrotic background containing large nuclei and a clear cytoplasm. (C) CD20 shows strong cytoplasmic positivity in the lymphoma cells. (D) CD10 stains approximately 60% of the lymphoma cells. (E) Lymphoma cells showing a strong cytoplasmic staining with CD79a. (F) Ki-67 shows a moderate to high proliferative rate (75%) in the lymphoma cells. HeartRhythm Case Reports 2016 2, 384-387DOI: (10.1016/j.hrcr.2016.05.002) Copyright © 2016 Heart Rhythm Society Terms and Conditions