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
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.