{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:49:36Z","timestamp":1771490976950,"version":"3.50.1"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T00:00:00Z","timestamp":1658448000000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Heart Foundation"},{"name":"JSPS"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Catheter ablation (CA) has been reported to be an effective therapeutic option for ventricular arrhythmias, even in patients with a left-ventricular assist device (LVAD). However, the issues of right-to-left shunting due to iatrogenic atrial septal defect (iASD) associated with procedures for CA have not been well documented. We describe a rare case of refractory hypoxia associated with right-to-left shunting via iASD after CA through the transseptal approach in an LVAD patient.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 52-year-old Asian man with a continuous-flow implantable LVAD and progressive right ventricular (RV) dysfunction was admitted because of refractory ventricular tachycardia (VT) and subsequent right heart failure. Since VT could not be controlled by intravenous administration of multiple antiarrhythmic drugs, VT ablation via the transseptal approach was performed. Ventricular tachycardia was terminated to the sinus rhythm after VT ablation; however, hypoxia associated with significant right-to-left shunting across the iASD was detected. Intensive medical management, such as an adjusted mechanical ventilator to increase pulmonary vascular compliance and adjustment of LVAD pump speed, as well as the use of intravenous inotropes to support impaired RV function successfully stabilized the haemodynamic and improved hypoxia for the disappearance of right-to-left shunting. Echocardiography at 7 months after CA showed that the significant iASD and right-to-left shunting had disappeared.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The evaluation of RV function prior to VT ablation via the transseptal approach is important in the postoperative management of patients with LVAD, because RV dysfunction may cause refractory hypoxia due to iASD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac277","type":"journal-article","created":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T11:28:22Z","timestamp":1658489302000},"source":"Crossref","is-referenced-by-count":5,"title":["Successful recovery from refractory hypoxia due to right-to-left shunting associated with iatrogenic atrial septal defect after catheter ablation in a patient with a left-ventricular assist device: a case report"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1468-3960","authenticated-orcid":false,"given":"Shotaro","family":"Komeyama","sequence":"first","affiliation":[{"name":"Department of Transplant Medicine, National Cerebral and Cardiovascular Center , 6-1, Kishibe-shinmachi, Suita , Osaka 564-0018, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takuya","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Transplant Medicine, National Cerebral and Cardiovascular Center , 6-1, Kishibe-shinmachi, Suita , Osaka 564-0018, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9571-7017","authenticated-orcid":false,"given":"Kenichiro","family":"Yamagata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center , Osaka 564-0018 , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1367-4066","authenticated-orcid":false,"given":"Norihide","family":"Fukushima","sequence":"additional","affiliation":[{"name":"Department of Transplant Medicine, National Cerebral and Cardiovascular Center , 6-1, Kishibe-shinmachi, Suita , Osaka 564-0018, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,7,22]]},"reference":[{"key":"2022072815290938200_ytac277-B1","doi-asserted-by":"crossref","first-page":"2542","DOI":"10.1016\/j.jacc.2013.04.020","article-title":"Ventricular arrhythmias and implantable cardioverter-defibrillator therapy in patients with continuous-flow left ventricular assist devices: need for primary prevention?","volume":"61","author":"Garan","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2022072815290938200_ytac277-B2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/europace\/eus364","article-title":"Ventricular arrhythmias in patients with implanted ventricular assist devices: a contemporary review","volume":"15","author":"Shirazi","year":"2013","journal-title":"Europace"},{"key":"2022072815290938200_ytac277-B3","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1016\/j.healun.2015.05.018","article-title":"Early postoperative ventricular arrhythmias in patients with continuous-flow left ventricular assist devices","volume":"34","author":"Garan","year":"2015","journal-title":"J Heart Lung Transplant"},{"key":"2022072815290938200_ytac277-B4","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1016\/j.hrthm.2009.04.030","article-title":"EHRA\/HRS expert consensus on catheter ablation of ventricular arrhythmias; developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA)","volume":"6","author":"Aliot","year":"2009","journal-title":"Heart Rhythm"},{"key":"2022072815290938200_ytac277-B5","doi-asserted-by":"crossref","first-page":"e166","DOI":"10.1016\/j.hrthm.2014.07.024","article-title":"EHRA\/HRS\/APHRS expert consensus on ventricular arrhythmias","volume":"11","author":"Pedersen","year":"2014","journal-title":"Heart Rhythm"},{"key":"2022072815290938200_ytac277-B6","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jacep.2018.08.009","article-title":"Catheter ablation of ventricular tachycardia in patients with a ventricular assist device. A systematic review of procedural characteristics and outcomes","volume":"5","author":"Anderson","year":"2019","journal-title":"JACC Clin Electrophysiol"},{"key":"2022072815290938200_ytac277-B7","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1007\/s10047-019-01128-0","article-title":"Patent foramen ovale-related complications in left ventricular assist device patients: a reappraisal for cardiovascular professionals","volume":"23","author":"Bacich","year":"2020","journal-title":"J Artif Organs"},{"key":"2022072815290938200_ytac277-B8","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1034\/j.1399-6576.2000.440122.x","article-title":"Intermittent atrial level right-to-left shunt with temporary hypoxemia in a patient during support with a left ventricular assist device","volume":"44","author":"Kilger","year":"2000","journal-title":"Acta Anaesthesiol Scand"},{"key":"2022072815290938200_ytac277-B9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/ccd.21185","article-title":"Percutaneous left ventricular assist device complicated by a patent foramen ovale: importance of identification and management","volume":"70","author":"Loyalka","year":"2007","journal-title":"Catheter Cardiovasc Interv"},{"key":"2022072815290938200_ytac277-B10","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s10840-008-9257-7","article-title":"Persistent iatrogenic atrial septal defect after pulmonary vein isolation: incidence and clinical implications","volume":"22","author":"Rillig","year":"2008","journal-title":"J Interv Card Electrophysiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytac277\/45047823\/ytac277.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/7\/ytac277\/45179881\/ytac277.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/6\/7\/ytac277\/45179881\/ytac277.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T15:33:01Z","timestamp":1659022381000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytac277\/6648394"}},"subtitle":[],"editor":[{"given":"Constantinos","family":"Bakogiannis","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Christoph Clemens","family":"Kaufmann","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Zaid","family":"Iskander","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Debbie","family":"Falconer","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Ameenathul Mazaya","family":"Fawzy","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,7,1]]},"references-count":10,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,7,6]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytac277","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,7,1]]},"published":{"date-parts":[[2022,7,1]]},"article-number":"ytac277"}}