Author + information
- Received November 22, 2017
- Accepted November 30, 2017
- Published online March 19, 2018.
- Kaustubha D. Patil, MD∗ ( and )
- David D. Spragg, MD
- Cardiac Arrhythmia Service, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- ↵∗Address for correspondence:
Dr. Kaustubha D. Patil, Cardiac Arrhythmia Service, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed 7122, Sheikh Zayed Building, Baltimore, Maryland 21287.
We present a unique complication occurring during cryoballoon pulmonary vein isolation (1). A 51-year-old woman with a history of coronary artery bypass and mechanical aortic valve replacement was referred for cryoballoon (Arctic Front Advance Cardiac CryoAblation Catheter System, Medtronic Inc., Minneapolis, Minnesota) pulmonary vein isolation to treat highly symptomatic, drug-refractory paroxysmal atrial fibrillation. Between the first and second freeze cycles at the right inferior pulmonary vein ostium, the Achieve mapping catheter was withdrawn into the balloon catheter and redeployed. During the subsequent freeze cycle, the distal portion of the Achieve catheter was noted to be separated from the remainder of the catheter. The fragment was visualized under fluoroscopy transiting from the left atrium to the left ventricle and systemic circulation (Online Video 1). Fluoroscopy showed that the fragment had embolized to the descending aorta (Figure 1). It was retrieved with an Amplatz GooseNeck Snare kit (Covidien Inc., Minneapolis, Minnesota) via 8-F right femoral arterial access (Figure 2). After retrieval, we proceeded to complete right inferior pulmonary vein isolation with radiofrequency ablation. All 4 pulmonary veins were successfully isolated; the patient was monitored for an extra day in the hospital and discharged in good condition. We believe this is the first report of Achieve catheter fracture and embolization in the setting of anticipated manipulation.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received November 22, 2017.
- Accepted November 30, 2017.
- 2018 American College of Cardiology Foundation