Entrapment of a J-tip guidewire within the pulmonary vein during FARAPULSETM pulsed field ablation. A case report

Abstract Background Pulsed field ablation (PFA) is a rapidly adopted technology for atrial fibrillation (AF) ablation and is associated with a favorable safety profile and a low risk of complications. However, mechanical complications have rarely been reported. Case summary A 37-year-old Asian male with paroxysmal AF underwent PFA using the FARAPULSETM system. Following successful ablation of the left superior pulmonary vein (PV), the J-tip guidewire advanced into the left inferior PV and became completely entrapped. Venography demonstrated that, although the guidewire tip remained intravascular, a proximal segment appeared to course along the vessel wall, suggesting passage through an intraluminal structure. Multiple attempts at withdrawal using push-pull maneuvers were unsuccessful. Repositioning with a radiofrequency ablation catheter also failed to release the entrapment. Given the risk of vessel rupture and major hemorrhage, the procedure was converted to general anesthesia in a hybrid operating room with surgical standby. Bridge occlusion balloon-assisted extraction successfully released the entrapped guidewire without vascular injury. The retrieved guidewire had adherent fibrous white tissue, suggesting entrapment by a membranous pulmonary venous structure. Discussion Balloon-assisted endovascular retrieval may represent a safe and less invasive alternative to surgical intervention for managing such entrapments. Operators should be aware of this rare but potentially hazardous complication.