Catheter entrapment in Chiari network: Extraction with radiofrequency

Abstract

We report a challenging case of a duodecapolar mapping catheter entrapment in Chiari network and its release by radiofrequency energy application with an ablation catheter.

Catheter entrapment in the Chiari network during catheter ablation

“…We considered different options to remove the entangled catheter: Traction and rotation movements, snare catheter, endomyocardial biopsy forceps, and radiofrequency energy application have been used to assist in the removal of entrapped catheters. 6 A surgical approach may be required if these fail. These techniques have been described for entrapment of circular mapping catheters but may also apply to other multielectrode mapping catheters.…”

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 ).…”