Iatrogenic Ventricular Septal Defect Following Simple PVC Ablation: A Case of Delayed Percutaneous Closure.

Background: Iatrogenic muscular ventricular septal defect (VSD) is a rare but serious complication of premature ventricular complex (PVC) ablation. Timely diagnosis and management are essential.

Case Summary: A 77-year-old woman underwent radiofrequency ablation for symptomatic parahisian PVCs. Radiofrequency applications up to 20 W for 30 seconds were used. Following ablation she presented with worsening heart failure symptoms. Multimodal imaging confirmed a hemodynamically significant irregular VSD measuring approximately 11 × 8 mm at the ablation site. Given her high surgical risk, successful delayed percutaneous closure was performed using an Amplatzer 12-mm muscular VSD occluder leading to resolution of symptoms.

Discussion: PVC ablation requires careful patient selection, particularly when targeting high-risk anatomy. Iatrogenic VSD requires early recognition and individualized management. Multimodal imaging is helpful in diagnosis and guiding management. Percutaneous closure may be an effective alternative to surgical closure.

Take-home Messages: Iatrogenic muscular VSD is a rare but serious complication of seemingly benign PVC ablation intended for symptom relief. Multimodality imaging can be useful for procedural planning, whereas catheter-based closure can be a safe and effective alternative to surgery.