Key result
Targeted aspiration successfully resolves left atrial appendage air entrapment during atrial fibrillation ablation.
Why the study?
Evidence guiding management of localized left atrial appendage air entrapment during atrial fibrillation ablation is limited.
Case Report (n=1)
An anatomy-oriented, stepwise aspiration strategy can be effective for managing localized left atrial appendage air entrapment during atrial fibrillation ablation.
Alerts to stopcock errors during ablation deairing; leaves open standardized management of localized LAA air entrapment.
BACKGROUND: Air embolism is a rare but potentially catastrophic complication of atrial fibrillation ablation, and evidence guiding management of localized left atrial appendage (LAA) air entrapment is limited. CASE SUMMARY: A 69-year-old woman undergoing ablation for persistent atrial fibrillation developed localized LAA air entrapment when incorrect positioning of a 3-way stopcock during deairing allowed air to enter the ablation-catheter irrigation circuit. Fluoroscopy prompted immediate cessation of ablation. Stepwise aspiration using the indwelling ablation catheter, a larger-bore sheath near the LAA ostium, and targeted catheter aspiration of residual distal air resulted in disappearance of the visible air shadow. Ablation was completed without further acute complications. DISCUSSION: This case illustrates an anatomy-oriented aspiration strategy for air confined within an angulated LAA recess. TAKE-HOME MESSAGES: Stopcock position and irrigation flow should be verified during deairing. Prompt recognition and cautious stepwise aspiration may facilitate management in selected cases.
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Zhou et al. (2026) conducted a case report in Persistent atrial fibrillation with localized left atrial appendage air entrapment (n=1). Targeted stepwise aspiration was evaluated on Disappearance of visible air shadow and completion of ablation. Stepwise targeted aspiration successfully resolved localized left atrial appendage air entrapment during atrial fibrillation ablation without further acute complications.
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