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Permanent Pacemaker-Mediated Exertional Hypoxemia in a Patient With Ebstein Anomaly
Ashish H Shah1, Nasir Shaikh1, Keivan Alizadeh1
1Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
JACC. Case Reports
|April 22, 2024
Summary
A permanent pacemaker lead inadvertently kept a patent foramen ovale open in a patient with Ebstein anomaly. This led to right-to-left shunting of blood, causing exertional hypoxemia, a novel finding in medical literature.
Area of Science:
- Cardiology
- Medical Case Reports
Background:
- Ebstein anomaly is associated with interatrial communications and blood shunting.
- Elevated right atrial pressure or tricuspid regurgitation can cause shunting in Ebstein anomaly.
Purpose of the Study:
- To report a unique case of a permanent pacemaker lead maintaining a patent foramen ovale.
- To highlight the resulting right-to-left shunting and exertional hypoxemia.
Main Methods:
- Case presentation of a patient with Ebstein anomaly.
- Description of findings related to pacemaker lead placement and patent foramen ovale.
Main Results:
- A permanent pacemaker lead was identified as the cause of an open patent foramen ovale.
- This anatomical change resulted in significant right-to-left shunting of blood.
- The shunting led to exertional hypoxemia in the patient.
Conclusions:
- This is the first reported case of a pacemaker lead maintaining a patent foramen ovale.
- This mechanism can lead to paradoxical embolism and hypoxemia in susceptible patients.
- Awareness of this complication is crucial for managing patients with Ebstein anomaly and pacemakers.
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