A case of an ablation catheter entrapped in the pulmonary vein during atrial fibrillation ablation requiring open heart surgery for removal☆

Case Report A 64-year-old woman with a 3-year history of drug refractory paroxysmal atrial fibrillation was referred to our hospital for catheter ablation. Preprocedual echocardiography and enhanced computed tomography (CT) revealed no structural heart disease or anatomic anomalies (Figure 1A). Catheter ablation of the atrial fibrillation was performed under conscious sedation. Two 8.5-F long sheaths, an 8-F long sheath, and a 6-F short sheath were introduced percutaneously via the right femoral vein. A 6-F venous sheath was introduced via the right internal jugular vein. A decapolar electrode catheter was positioned in the right ventricular apex. A duodecapolar electrode catheter was advanced into the coronary sinus. A transseptal puncture was performed with the assistance of intracardiac echocardiography using a radiofrequency needle (Japan Lifeline, Tokyo, Japan). Three long sheaths were advanced into the left atrium through the same puncture site. Pulmonary vein (PV) and left atrial angiogram revealed no anatomic anomalies, and the sheaths were placed into the superior PVs. Two circular mapping catheters were positioned in the PVs. An ablation catheter (Thermocool Smart Touch, Biosense Webster, Diamond Bar, CA) was inserted into the 8.5-F sheath placed in the right superior PV. The ablation catheter was pulled back and moved to start the ablation. The operator intended to place the ablation catheter into the left PV and pushed the