{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T06:24:58Z","timestamp":1787034298984,"version":"build-2736575974"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":228,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Cardiology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ventricular fibrillation (VF) is a life\u2010threatening complication of acute coronary syndrome (ACS) and requires rapid identification and correction of reversible ischemic triggers. ST\u2010segment elevation in aVR with diffuse ST depression reflects global subendocardial ischemia but is not specific for left main or proximal left anterior descending disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary<\/jats:title>\n                    <jats:p>A 62\u2010year\u2010old male with prior coronary stent placement presented with acute chest pain, diaphoresis, nausea, and vomiting. An electrocardiogram demonstrated ST\u2010segment elevation in aVR with ST depressions in V3\u2013V6. Laboratory testing demonstrated severe metabolic acidosis (pH\u20097.07; bicarbonate 10.3\u2009mEq\/L), lactate 3.7\u2009mmol\/L, and high\u2010sensitivity troponin rising from 427 to 4991\u2009ng\/L within 2\u2009h. During emergent angiography, VF developed after left ventricular catheter manipulation and recurred repeatedly while attempting to cross a heavily calcified 99% proximal left circumflex (LCx) lesion. Over 20\u201330\u2009min, 11 VF episodes required immediate defibrillation, manual chest compressions, and intravenous amiodarone. VF ceased only after LCx stenting restored TIMI Grade 3 flow. The patient\u2032s maximum intraprocedural shock severity met SCAI Stage E criteria because of recurrent cardiac arrest, multiple defibrillations, and severe acidosis. An Impella microaxial flow pump was placed for temporary postresuscitation circulatory support and maintained at P4. A postreperfusion echocardiogram obtained during ongoing support showed an LVEF of approximately 60%. The device was removed within 48\u2009h after hemodynamic recovery. Staged intravascular lithotripsy\u2010assisted PCI of the calcified mid\u2010LAD lesion was performed on Day 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case demonstrates that refractory ischemia\u2010mediated VF may terminate only after culprit\u2010vessel reperfusion. A preserved LVEF measured after reperfusion during mechanical support does not exclude earlier SCAI Stage E shock. Short\u2010duration Impella support may serve as an individualized bridge during recovery from recurrent arrest and transient circulatory collapse.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/cric\/2641470","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:33:38Z","timestamp":1787031218000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refractory Intraprocedural Ventricular Fibrillation From Left Circumflex Culprit Occlusion Managed With Culprit PCI and Short\u2010Duration Impella Support"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4987-1899","authenticated-orcid":false,"given":"Vineet","family":"Madishetty","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4951-694X","authenticated-orcid":false,"given":"Alexander","family":"Yaylayan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Yelamanchili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merrill","family":"Krolick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra000650"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.600"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(01)01563-7"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.14503\/THIJ-16-5905"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.01.018"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.03.024"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2312572"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.66.6.1146"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccl.2022.02.004"},{"key":"e_1_2_13_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm14040438"}],"container-title":["Case Reports in Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/cric\/2641470","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/cric\/2641470","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/cric\/2641470","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:33:38Z","timestamp":1787031218000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/cric\/2641470"}},"subtitle":[],"editor":[{"given":"Satabdi","family":"Datta Choudhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/cric\/2641470"],"URL":"https:\/\/doi.org\/10.1155\/cric\/2641470","archive":["Portico"],"relation":{},"ISSN":["2090-6404","2090-6412"],"issn-type":[{"value":"2090-6404","type":"print"},{"value":"2090-6412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-05-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"2641470"}}