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Successful removal of a circular mapping catheter which perforated the pulmonary vein during cryoballoon ablation by lateral thoracotomy: a case report.

ABSTRACT: Background:Serious complications may occur during cryoballoon ablation (CBA). However, pulmonary vein (PV) perforation by a circular mapping catheter and the strategy for removing the catheter remain poorly understood. Case summary:A 40-year-old male presented with palpitations 2?years ago and was diagnosed with paroxysmal atrial fibrillation 5?months ago. He underwent CBA for paroxysmal atrial fibrillation. After isolation of the left PV, a circular mapping catheter was advanced in the right inferior pulmonary vein (RIPV), and single freeze was performed. After isolation of the PV, the catheter tip was immobile and could not be withdrawn with significant resistance. Computed tomography showed that the catheter tip perforated the posterior basal vein (V10) of the RIPV and remained in the right lower lobe, along with intrapulmonary haemorrhage. The patient underwent surgery via right lateral thoracotomy to remove the catheter. The RIPV was peeled to the periphery to expose the V10. The catheter perforated the vessel wall in the middle of the V10 and entered the pulmonary parenchyma. A microincision on the lung parenchyma covering the surface of the catheter tip was performed, and the circular distal portion of the catheter was cut. The entire catheter (i.e. shaft and proximal portion) was successfully removed from the transseptal catheter. Discussion:Surgical approach was performed for the management of PV perforation caused by a circular mapping catheter. This case may assist in troubleshooting and problem-solving in case such an event occurs again during procedures in the future.

SUBMITTER: Yoshizawa R

PROVIDER: S-EPMC7501890 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Successful removal of a circular mapping catheter which perforated the pulmonary vein during cryoballoon ablation by lateral thoracotomy: a case report.

Yoshizawa Reisuke R Owada Shingen S Sawa Yohei Y Deguchi Hiroyuki H

European heart journal. Case reports 20200706 4

<h4>Background</h4>Serious complications may occur during cryoballoon ablation (CBA). However, pulmonary vein (PV) perforation by a circular mapping catheter and the strategy for removing the catheter remain poorly understood.<h4>Case summary</h4>A 40-year-old male presented with palpitations 2 years ago and was diagnosed with paroxysmal atrial fibrillation 5 months ago. He underwent CBA for paroxysmal atrial fibrillation. After isolation of the left PV, a circular mapping catheter was advanced ...[more]

PMID: 32974434

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Project description:Background The natural history of autonomic alterations following catheter ablation of drug-refractory paroxysmal atrial fibrillation is poorly defined, largely because of the historical reliance on non-invasive intermittent rhythm monitoring for outcome ascertainment. Methods and Results The study included 346 patients with drug-refractory paroxysmal atrial fibrillation undergoing pulmonary vein isolation using contemporary advanced-generation ablation technologies. All patients underwent insertion of a Reveal LINQ (Medtronic) implantable cardiac monitor before ablation. The implantable cardiac monitor continuously recorded physical activity, heart rate variability (measured as the SD of the average normal-to-normal), daytime heart rate, and nighttime heart rate. Longitudinal autonomic data in the 2-month period leading up to the date of ablation were compared with the period from 91 to 365 days following ablation. Following ablation there was a significant decrease in SD of the average normal-to-normal (mean difference versus baseline of 19.3 ms; range, 12.9-25.7; P<0.0001), and significant increases in daytime and nighttime heart rates (mean difference versus baseline of 9.6 bpm; range, 7.4-11.8; P<0.0001, and 7.4 bpm; range, 5.4-9.3; P<0.0001, respectively). Patients free of arrhythmia recurrence had significantly faster daytime (11±11 versus 8±12 bpm, P=0.001) and nighttime heart rates (8±9 versus 6±8 bpm, P=0.049), but no difference in SD of the average normal-to-normal (P=0.09) compared with those with atrial fibrillation recurrence. Ablation technology and cryoablation duration did not influence these autonomic nervous system effects. Conclusions Pulmonary vein isolation results in significant sustained changes in the heart rate parameters related to autonomic function. These changes are correlated with procedural outcome and are independent of the ablation technology used. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01913522.

Dataset Information

Successful removal of a circular mapping catheter which perforated the pulmonary vein during cryoballoon ablation by lateral thoracotomy: a case report.

Publications

Successful removal of a circular mapping catheter which perforated the pulmonary vein during cryoballoon ablation by lateral thoracotomy: a case report.

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