Untying of diagnostic decapolar catheter knot using a steerable sheath and ablation catheter

A 67-year-old man underwent electrophysiology study for typical right atrial flutter. A decapolar catheter (InquiryTM, Irvine, CA, USA) was planned to be advanced into the coronary sinus via a 7  Fr sheath in the femoral vein. Initially, manipulation with the catheter was performed without fluoroscopic guidance, with fluoroscopy it revealed a helical-shaped, knot-like structure (left panel). Gentle traction or rotation did not allow catheter withdrawal. To solve the problem, a steerable AgilisTM NxT sheath (8.5  Fr/91 cm, St. Jude Medical, MN, USA) with an 8-mm ablation catheter Alcath (Biotronik, Berlin, Germany) was advanced into the right atrium. Subsequently, the knotted catheter was pushed from the femoral vein into the heart. While the tip of the catheter was stacked in the pelvic veins, the body of the catheter formed a long loop reaching to the right atrium. This loop was hooked (middle panel) by the above assembly introduced from the right internal jugular vein and by gentle traction the eye of the knot was slowly loosened and the catheter was retracted into the right atrium, unhooked and pulled back via the right femoral vein. After removal of the decapolar catheter, a significant ‘camel like’ double hump deformation was observed on its shaft (right panel).
Source: Europace - Category: Cardiology Source Type: research