An uncommon case of inferior vena cava injury during atrial fibrillation ablation

Abstract

A 64-year-old man underwent catheter ablation (CA) of atrial fibrillation with intracardiac echocardiography (ICE) assistance. As the probe was advanced toward the right atrium, sudden abdominal pain was felt by the patient with hypotension and tachycardia requiring fluids and vasopressors for hemodynamic stabilization. The inferior vena cava (IVC) was injured by the passing probe and open repair was then performed. To our knowledge, this is the first reported case of symptomatic IVC laceration by the probe used for ICE during CA.

A Percutaneous Treatment to Inferior Vena Cava Perforation by Intracardiac Echocardiography Catheter After an Unsuccessful Conservative Approach

“…To our knowledge, this is the second reported case of symptomatic IVC injury due to an ICE probe during CA and the first with an interventional vascular approach with a covered grafted stent with no need for open surgical repair 3,10 . This experience corroborates the findings of other authors that endograft stent placement in the IVC is safe, effective, and potentially life-saving in some cases.…”

Percutaneous Treatment to Inferior Vena Cava Perforation by Intracardiac Echocardiography Catheter after an Unsuccessful Conservative Approach

“…To our knowledge, this is the second reported case of symptomatic IVC injury due to an ICE probe during CA and the first with an interventional vascular approach with a covered grafted stent with no need for open surgical repair 3,10 . This experience corroborates the findings of other authors that endograft stent placement in the IVC is safe, effective, and potentially lifesaving in some cases.…”

“…Nevertheless, vascular complications remain the most common adverse events related to catheter-based CA, likely due to the number and size of intravascular sheaths and the use of periprocedural anticoagulation. As an increasing movement of zero-fluoroscopy electrophysiology procedures performing worldwide 3,4 , the adequate use of the ICE catheter and the knowledge of possible and life-threatening complications can occur. Appropriate manipulation of the catheter and direct visualization of the venous trajectory from the sheath to the right atrial must be addressed by the operator to avoid the kind of complication described in this manuscript.…”