Successful transvenous retrieval of an electrode ring dislodged from a novel visualized steerable sheath by inflation of a balloon inside the ring

The VIZIGO sheath (Biosense Webster, Irvine, CA, USA) is used for catheter ablation (CA) of atrial arrhythmia. In this case report, we describe a complication associated with the VIZIGO sheath and present a successful bailout method. An 82-year-old woman with paroxysmal atrial fibrillation (AF) and atrial tachycardia (AT) was referred to our hospital after experiencing palpitations for 6 months. She underwent CA using the VIZIGO sheath and a fixed Swartz sheath (St. Jude Inc., St. Paul, MN, USA). Pulmonary vein isolation and left atrial posterior wall isolation were performed to address AF and AT. Following ablation, the Swartz sheath was removed; however, the VIZIGO sheath showed resistance to removal. A wire was inserted into the VIZIGO sheath for removal, but the distal electrode ring detached in the vessel. To retrieve the electrode ring, a Mustang over-the-wire angioplasty balloon was dilated inside the ring and withdrawn with the ring. After venography and confirmation of a hemostatic seal, the ablation procedure was completed. The patient experienced postoperative anemia, which was resolved by erythrocyte transfusion. No further paroxysmal AF or AT occurred during the 1-year follow-up. In conclusion, the VIZIGO sheath's distal electrode ring may become detached during CA, and the detached ring can be successfully retrieved using our original bailout technique. Learning objective: This case report highlights the unique complication of electrode ring detachment associated with the novel visualized steerable sheath (VIZIGO; Biosense Webster, Irvine, CA, USA) during catheter ablation procedures and presents the successful technique as a bailout method for retrieving the dislodged ring. The technique involves dilating a non-compliant over-the-wire angioplasty balloon inside the ring and withdrawing it along with the detached ring.