A knotted ablation catheter in the arterial system was successfully untied by cutting the external portion and advancing a large-bore sheath over it to maneuver against the aortic valve.
Case Report (n=1)
Advancing a large-bore sheath over a cut catheter to maneuver against the aortic valve is a viable bailout strategy for arterial catheter knotting during electrophysiological procedures.
ABSTRACT Catheter knotting is a rare but potentially serious complication encountered during electrophysiological procedures. We report an unusual case of catheter ablation for premature ventricular complexes (PVCs) arising from anterolateral papillary muscle, where a ThermoCool SmartTouch (ST) catheter (Biosense Webster, Irvine, CA) developed a knot within the arterial system during transaortic mapping. The knot formed after the catheter was inadvertently withdrawn into the ascending aorta and re‐advanced, leading to looping and tip entrapment. Standard maneuvers to untie the knot were unsuccessful. As a novel bailout strategy, the external portion of the catheter was cut near the handle and a large‐bore 8.5 SL0 sheath (Swartz Braided SL Transseptal Guiding Introducer Sheath; length 63 cm) was advanced over it. The knotted catheter was then maneuvered against the aortic valve, and controlled mechanical contact led to successful loosening of knot and sheath retrieval. This case underscores the importance of early recognition, careful manipulation, and innovative problem‐solving in managing rare mechanical complications in the cardiac electrophysiology lab.
Arya et al. (Thu,) conducted a case report in Premature ventricular complexes (PVCs) (n=1). Catheter ablation and bailout strategy using a large-bore sheath was evaluated. A knotted ablation catheter in the arterial system was successfully untied by cutting the external portion and advancing a large-bore sheath over it to maneuver against the aortic valve.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: