Atrio-ventricular block from metastatic lung cancer to the aortic root

A 51-year-old man with stage IV squamous cell lung cancer presented with complete heart block and a left fascicular escape rhythm unresponsive to epinephrine therapy (PanelA). Echocardiography revealed a large, irregular 2.2 × 2.1 cm lung metastasis (arrows) to the right atrio-ventricular groove just opposite to the non-coronary cusp of the aortic valve and a globular left septal metastasis immediately beneath the right coronary cusp (PanelB). Herein is a rare case of lung carcinoma metastatic to the aortic root with invasion of the His-Purkinje system causing atrio-ventricular block and a fascicular escape rhythm.