May 1, 2023European Heart Journal - Case ReportsOpen Access

MitraClip detachment after electrical cardioversion: a case report

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Why the study?

Cardioversion is considered safe post-mitral clip, but data on complications such as single leaflet detachment following electrical cardioversion are lacking.

Structured PICO

Population

1 86-year-old female with severe mitral regurgitation undergoing transcatheter edge-to-edge repair (TEER)

Intervention

Electrical cardioversion for tachycardia during TEER procedure

Outcome

Single leaflet detachment (SLD) of the MitraClipsafety

This first report of single leaflet detachment following electrical cardioversion during TEER highlights a potential mechanical complication from acute post-cardioversion ventricular volume changes.

Implication

Cardioversion after TEER may risk single leaflet detachment; this case leaves open questions on procedural safety.

Abstract

Background: Transcatheter edge-to-edge repair (TEER) repair is a minimally invasive procedure used for patients with severe mitral regurgitation (MR). Cardioversion is indicated for haemodynamically unstable patients with narrow complex tachycardia and is generally considered safe post-mitral clip. We present a patient who underwent cardioversion post-TEER with a single leaflet detachment (SLD). Case summary: An 86-year-old female with severe MR underwent TEER with a MitraClip that reduced MR severity to mild. During the procedure, the patient experienced tachycardia, and cardioversion was performed successfully. However, immediately after the cardioversion, the operators noticed recurrent severe MR with a posterior leaflet clip detachment. Deployment of a new clip adjacent to the detached one was obtained. Discussion: Transcatheter edge-to-edge repair is a well-established method for treating severe MR in patients who are not suitable for surgical intervention. However, complications can arise during or after the procedure, such as clip detachment as in this case. Several mechanisms can explain SLD. We presumed that in the current case, immediately after cardioversion, there was an acute (post-pause) increase in left ventricle end-diastolic volume and thus in the left ventricle systolic volume with more vigorous contraction, possibly pulling apart the leaflets and detaching the freshly applied TEER device. This is the first report of SLD related to electrical cardioversion after TEER. Even though electrical cardioversion is considered safe, SLD can occur in this setting.