Postgraduate medical journal
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A 68 year old man presented with syncope associated with episodes of sinus arrest. He responded to insertion of a demand pacemaker. ⋯ Before further assessment could be made, he developed rapid atrial fibrillation, resistant to several anti-arrhythmic agents and died several days after admission. At autopsy a nodular plaque of lymphoma was found to overly the sinoatrial node which was markedly fibrosed with evidence of lymphomatous infiltration of the surrounding microvasculature.