{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T03:13:17Z","timestamp":1768619597002,"version":"3.49.0"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Suicide left ventricle (LV) is a rare, potentially fatal complication after transcatheter aortic valve implantation (TAVI). It is typically caused by dynamic left ventricular outflow tract obstruction (LVOTO) following abrupt afterload reduction. Accelerated junctional rhythm (AJR) is an uncommon peri-procedural arrhythmia, and its role in precipitating suicide LV has not been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 87-year-old woman with extremely severe aortic stenosis was admitted for transfemoral TAVI. Concentric LV hypertrophy with a sigmoid septum and preserved systolic function was observed on baseline transthoracic echocardiography. She developed profound hypotension immediately after valve deployment. Transoesophageal echocardiography (TOE) revealed severe LVOTO and marked mitral regurgitation (MR) due to systolic anterior motion (SAM) of the mitral valve. The simultaneous appearance of AJR abolished atrial contraction, further reducing LV preload. Left ventricular outflow tract obstruction and SAM resolved during sinus rhythm, but recurred during AJR. Haemodynamics improved with rapid volume loading, vasoconstrictor administration and continuous right ventricular pacing, thereby reducing obstruction via induced ventricular dyssynchrony. Accelerated junctional rhythm resolved spontaneously following emergence from anaesthesia, and a stable sinus rhythm was maintained. The patient was discharged on postoperative Day 12 without recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case reports AJR as a novel trigger for suicide LV after TAVI, leading to preload reduction and promoting SAM, LVOTO, and MR. Intraoperative TOE provided clear rhythm-dependent imaging of LVOT dynamics. Vigilant rhythm monitoring and prompt, targeted haemodynamic management, including pacing to induce ventricular dyssynchrony, are crucial for prevention and treatment in predisposed patients with small, hypertrophied ventricles with a sigmoid septum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf665","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T13:04:56Z","timestamp":1766149496000},"source":"Crossref","is-referenced-by-count":0,"title":["Suicide left ventricle triggered by accelerated junctional rhythm after transcatheter aortic valve implantation: a case report of rhythm-dependent dynamic left ventricular outflow tract obstruction"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4593-7158","authenticated-orcid":false,"given":"Naoki","family":"Hoshino","sequence":"first","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital , Room S1-504, 1-98 Dengaku, Kutsukake, Toyoake ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chihiro","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital , Room S1-504, 1-98 Dengaku, Kutsukake, Toyoake ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Muramatsu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital , Room S1-504, 1-98 Dengaku, Kutsukake, Toyoake ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital , Room S1-504, 1-98 Dengaku, Kutsukake, Toyoake ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2136-2855","authenticated-orcid":false,"given":"Hideo","family":"Izawa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital , Room S1-504, 1-98 Dengaku, Kutsukake, Toyoake ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"2026011611070781300_ytaf665-B1","first-page":"616","article-title":"Suicide left ventricle following transcatheter aortic valve implantation","volume":"76","author":"Suh","year":"2010","journal-title":"Catheter Cardiovasc Interv"},{"key":"2026011611070781300_ytaf665-B2","doi-asserted-by":"crossref","first-page":"102065","DOI":"10.1016\/j.jaccas.2023.102065","article-title":"Overcoming the obstacle of suicide left ventricle after transcatheter aortic valve replacement phenomenon","volume":"26","author":"Koliastasis","year":"2023","journal-title":"JACC Case Rep"},{"key":"2026011611070781300_ytaf665-B3","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.hrcr.2020.07.012","article-title":"Junctional rhythm following transcatheter aortic valve replacement","volume":"6","author":"Angsubhakorn","year":"2020","journal-title":"HeartRhythm Case Rep"},{"key":"2026011611070781300_ytaf665-B4","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/j.jaccas.2021.04.035","article-title":"Dynamic left ventricular outflow tract obstruction post-transcatheter aortic valve replacement","volume":"3","author":"Weich","year":"2021","journal-title":"JACC Case Rep"},{"key":"2026011611070781300_ytaf665-B5","doi-asserted-by":"crossref","first-page":"ytaa565","DOI":"10.1093\/ehjcr\/ytaa565","article-title":"Haemodynamic collapse immediately after transcatheter aortic valve implantation due to dynamic intraventricular gradient: a case report and review of the literature","volume":"5","author":"Endo","year":"2021","journal-title":"Eur Heart J Case Rep"},{"key":"2026011611070781300_ytaf665-B6","first-page":"122","article-title":"Right ventricular pacing for hypertrophic obstructive cardiomyopathy: meta-analysis and meta-regression of clinical trials","volume":"5","author":"Arnold","year":"2019","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2026011611070781300_ytaf665-B7","doi-asserted-by":"crossref","first-page":"1227217","DOI":"10.3389\/fcvm.2023.1227217","article-title":"Contemporary European practice in transcatheter aortic valve implantation: results from the 2022 European TAVI pathway registry","volume":"10","author":"Rosseel","year":"2023","journal-title":"Front Cardiovasc Med"}],"container-title":["European Heart Journal - 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