Detached tip of a transseptal sheath during left atrial ablation

Abstract

Left atrial ablation has become more commonplace with the advent of catheter ablation for atrial fibrillation. A number of transseptal sheaths have been produced to enhance safe and efficient catheter manipulation in the left atrium (LA) for these procedures. Some of the sheaths have been subject to recall due to partial or complete detachment of its radiopaque tip. We report a case of a 46 year-old female diagnosed with idiopathic dilated cardiomyopathy that presented with atypical left atrial flutter. During electrophysiologic study, a Swartz braided SL1 (SL-1) transseptal sheath was used to introduce the ablation catheter to the left atrium. During left atrial mapping, the radiopaque tip of the sheath detached from the rest of the sheath and was seen floating in the LA. After exchanging the SL-1 sheath with a deflectable sheath, the detached segment was retrieved out of the LA and eventually out of the vascular system using an angioplasty balloon advanced over a wire and inflated distal to the lumen of the detached tip. The root cause of this malfunction was found to be lack of a secondary bonding process that these sheaths generally undergo during the manufacturing process. We describe the case of a left atrial ablation procedure where a novel percutaneous method was able to successfully retrieve the detached tip of a transseptal sheath from the vascular system, thereby avoiding a potential catastrophic complication or thoracotomy. This method may be useful in other cases where similar circumstances may present.

Transseptal Access to the Left Atrium: Tips and Tricks to Keep it Safe Derived from Single Operator Experience and Review of the Literature

“…An incidence of 0.4% of transient ST elevation was reported in a large cohort study, whith no observed sequelae [ 32 ]. Other rare complication that may be encountered includes detached tips of the transseptal sheaths [ 34 ].…”

Retrieval of a detached transseptal sheath tip from a right pulmonary artery branch following catheter ablation

“…Detachment and embolization of foreign bodies occur most frequently during cardiovascular procedures, including percutaneous coronary intervention , transseptal electrophysiology studies/ablations , and percutaneous shunt closures . Foreign bodies are reported to have embolized to diverse parts of the vasculature, including great vessels, pulmonary arteries, right/left atrium, and coronary arteries .…”