Successful release of entrapped circumferential mapping catheters in patients undergoing pulmonary vein isolation for atrial fibrillation.
OBJECTIVE
The purpose of this study was to demonstrate a method for successful and safe release of an entrapped circular catheter.


BACKGROUND
Segmental pulmonary vein (PV) isolation is widely practiced for patients with symptomatic drug-refractory atrial fibrillation. A circular mapping catheter is sometimes used with this technique to map the electrical connection between the left atrium (LA) and the PVs. This catheter reportedly can become entrapped in the mitral valve apparatus. Attempts to free the entrapped catheter can result in serious complications, including damage to the mitral valve chordae tendineae or fracture of the catheter itself.


METHODS
Three patients were referred for PV isolation for atrial fibrillation. A circular mapping catheter was used to map the sites of LA-PV electrical connections.


RESULTS
During the procedure, the circular mapping catheter became entrapped in the mitral valve apparatus in two patients and in the PV in one patient. A series of maneuvers, which included use of another catheter and guiding sheaths as well as pushing forward rather than pulling back on the entrapped catheter, allowed safe and successful release of the entrapped catheter in all patients.


CONCLUSIONS
Entrapment of the circular mapping in the mitral valve apparatus or the PVs during PV isolation is a rare complication associated with use this catheter. We describe a series of maneuvers that may allow safe and successful release of the entrapped catheter.
Mansour
Moussa
M
Cardiac Arrhythmia Unit, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Mela
Theofanie
T
Ruskin
Jeremy
J
Keane
David
D
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac / Q000295:instrumentation*; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000628:therapy*; D006801:Humans; D008297:Male; D008943:Mitral Valve; D011664:Pulmonary Valve