Entrapment of high-density grid mapping catheter in a percutaneous ventricular assist device pigtail during ventricular tachycardia ablation with percutaneous hemodynamic support

Figures

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  Figure 1. A: Induction of clinical ventricular tachycardia (VT) with right bundle, right superior axis, which was localized to the anterior and inferior septum. B: Cardiac magnetic resonance imaging demonstrates severe global left ventricular systolic dysfunction with focal partial-thickness subendocardial late gadolinium enhancement in the anterior, anteroseptal, and anterolateral waves, corresponding to region where critical isthmus was mapping in VT, along with fractioned potentials and deceleration zone with right ventricular pacing wavefront.

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  Figure 2. A: Fluoroscopy showing entanglement of the Optrell mapping catheter (Biosense Webster, Irvine, CA) and Impella CP (Abiomed, Danvers, MA). The catheter was carefully disentangled under fluoroscopic guidance. B: Recreation of catheter entanglement outside the body. C: Impella CP (top) along with Optrell mapping catheter (bottom). D: The Impella 5.5 (top) can provide up to 5.5 L of mechanical support through axillary cutdown access and does not use a pigtail, compared to the Impella CP (bottom). The Impella CP pigtail poses a risk for entanglement with the Optrell mapping catheter.