Provocative Cases -> Teaching Case Reports D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-097 - Achieve Circular Catheter Tip Entrapment, Shear And Embolization During Cryoablation (ID 87)

 C.A. Hadadi: Nothing relevant to disclose.


Background: Circular mapping catheter entrapment in cardiac structures is a rare but serious complication. Clockwise rotation of the catheter is usually recommended to avoid trapping the leading edge of the catheter within pulmonary vein (PV) or valve apparatus.
Objective: We present the case of entrapment of the Achieve circular catheter in the left inferior PV with tip shear due to excessive clockwise rotation complicated by distal embolization requiring removal via femoral snare workstation.
Results: A 54-year-old lady presented for elective catheter ablation of atrial fibrillation. In the process of maneuvering the Achieve catheter into the left inferior PV, the catheter tip became enmeshed in the vein and would not pull back. Clockwise rotation to attempt to free the trapped catheter led to excessive torque buildup and shearing of the catheter tip. Fluoroscopy and echocardiography were able to visualize the catheter tip free floating in the left atrium and subsequent embolization to the abdominal aorta. Using a snare catheter, the dislodged tip of the Achieve catheter was successfully snared and withdrawn fully out of the body.
Conclusion: Catheter entrapment in a PV with subsequent tip shear and embolization has not been previously described in the literature. Our case illustrates the risks of unidirectional catheter manipulation and the necessity for operator familiarity with snare techniques.