Avulsion of coronary sinus after mapping in the great cardiac vein

A 21-year-old woman was referred for catheter ablation of a symptomatic premature ventricular contraction (PVC). Twelve-lead electrocardiography of outflow tract PVC showed with an R wave pattern break in the precordial leads V2 suggesting an origin close to the anterior interventricular sulcus. Mapping and ablation were initially performed in right ventricular outflow tract and left coronary cusp using a 3.5-mm tip catheter (ThermoCool SmartTouch; Biosense Webster, Diamond Bar, CA, USA) but had no effect on the PVCs. Then the great cardiac vein (GCV) mapping was performed, the catheter was wedged into the distal GCV and failed to be pulled back. Isosorbide dinitrate and lidocaine were injected repeatedly, but the catheter could not be retracted completely. Sustained traction for 10 min gradually freed the catheter with avulsion of the GCV intima (Figure). The distal coronary sinus could not be visualized by retrograde venography suggesting possible thrombus formation. No pericardial effusions occurred during the observation, and the chest pain improved finally. To our knowledge, this is the first case report about the GCV avulsion due to the stuck catheter.

Source: Europace - July 13, 2020 Category: Cardiology Source Type: research