Accidental Entrapment of Electrical Mapping Catheter by Chiari’s Network in Right Atrium during Catheter Ablation Procedure

Abstract

A 78-year-old male was admitted to our hospital due to frequent palpitation. His electrocardiogram (ECG) presented regular narrow QRS tachycardia with 170 bpm, and catheter ablation was planned. During electroanatomical mapping of the right atrium (RA) with a multiloop mapping catheter, the catheter head was entrapped nearby the ostium of inferior vena cava. Rotation and traction of the catheter failed to detach the catheter head from the RA wall. Exfoliation of connective tissue twined around catheter tip by forceps, which were designed for endomyocardial biopsy, succeeded to retract and remove the catheter. Postprocedural echocardiography and pathologic examination proved the existence of Chiari's network. The handling of complex catheters in the RA has a potential risk of entrapment with Chiari's network.

Surgical Removal of a Pacemaker Lead Entrapped by a Chiari Network: A Case Report

“…It is also worth noting that attention should be paid to Chiari networks since the network might entrap medical devices such as pacemaker leads [5][6][7], catheters [8,9], and even wires [10,11], although the incidence of complications associated with Chiari networks remains unknown. On these occasions, surgical removal is generally selected after multiple unsuccessful attempts at removal, as in the current patient.…”

A case of Chiari network and paradoxical emboli

“…Several disturbances such as PFO, paradoxical emboli, clot formation, infective endocarditis, heart failure, and supraventricular arrhythmia are reported [5,[8][9][10][11]. Also preventing from right atrium catheter implantation, pace wire lead insertion and CPB cannulation are related to Chiari network [12][13][14]. In thrombophilia it acts such as inferior vena cava filter and prevents emboli [15].…”

Da Vinci Anatomy Card #1: The Eustachian Valve and its Implications in Invasive Cardiology and Cardiac Surgery

“…Variations in EV anatomy may impede access to the right-sided chambers. Filament-like extensions arising from the EV, known as the Chiari network, which are a remnant of the embryological right valve of the sinus venosus, are commonly seen on transesophageal and intracardiac echocardiographs and, depending on its extent and structure, may hinder catheter advancement from the IVC into the RA ( Video 1 ) and occasionally lead to catheter or guidewire entanglement ( 5 , 6 , 7 , 8 ). Sub-EV pouches (known as sub-eustachian recesses) are present in up to 45% of individuals ( 9 ) and have been associated with longer radiofrequency applications required to achieve bidirectional blockage across the cavotricuspid isthmus in typical atrial flutter ablations ( 10 ).…”