Right-to-left shunt via iatrogenic atrial septal defect requiring emergency surgical repair following cryoballoon atrial fibrillation ablation in a patient with arrhythmogenic right ventricular cardiomyopathy. Issue 1 (January 2023)

• Record Type: Journal Article
• Authors: Narui, Ryohsuke; Yamashita, Seigo; Yoshitake, Michio; Nagoshi, Tomohisa; Kunihara, Takashi; Yoshimura, Michihiro; Yamane, Teiichi
• Is Part Of: Journal of cardiology cases. Volume 27:Issue 1(2023)
• Page Start: 16
• Page End: 18
• Publication Date: 2023-01
• Subjects: AF atrial fibrillation -- AFL atrial flutter -- ARVC arrhythmogenic right ventricular cardiomyopathy -- PVI Pulmonary vein isolation -- IASD iatrogenic atrial septal defect -- TTE transthoracic echocardiography -- TR tricuspid regurgitation -- LV left ventricle -- LA left atrium -- SpO2 systemicoxygen saturation -- TVP tricuspid valvuloplasty; Atrial fibrillation -- Ablation -- Cryoballoon -- Arrhythmogenic right ventricular cardiomyopathy -- Iatrogenic atrial septal defect; Cardiology -- Periodicals; Cardiovascular Diseases -- Case Reports; Cardiovascular Diseases -- Periodicals; Cardiology -- Case Reports; Cardiology -- Periodicals; Cardiology; Electronic journals; Periodicals; 616.12
• DOI: 10.1016/j.jccase.2022.09.008
• Languages: English
• ISSNs: 1878-5409

Abstract

Abstract: An 81-year-old woman with arrhythmogenic right ventricular cardiomyopathy underwent catheter ablation for atrial fibrillation and atrial flutter. Hypoxemia refractory to the administration of oxygen was seen after transseptal puncture. Transthoracic echocardiography revealed right to left shunt via an iatrogenic atrial septal defect (IASD) that was increased by tricuspid regurgitation flow. Her hypoxemia improved after IASD occlusion with the inflation of a venogram balloon catheter. Emergent surgical IASD closure was successfully performed. IASD after transseptal puncture for atrial fibrillation ablation infrequently causes severe complications that require emergent repair. Learning objective: Some cases requiring iatrogenic atrial septal defect (IASD) closure after atrial fibrillation (AF) ablation have been reported. We describe the case of an arrhythmogenic right ventricular cardiomyopathy patient with right to left shunt via an IASD which required emergent surgical repair after AF ablation. Right to left shunt after trans-septal puncture is rare, however it can be an emergent life-threatening complication. IASD occlusion with venogram balloon catheter is helpful for the diagnosis and the short-term solution.