PMC:6019327 / 502046-503410 JSONTXT

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of a circular multielectrode mapping catheter by the mitral valve apparatus is an uncommon but established complication of AF ablation.1262,1263,1264,1265,1266,1267,1268,1396 It results from inadvertent positioning of a circular electrode catheter close to the mitral valve or into the left ventricle, often during attempts to position the catheter into the LIPV or when using such catheters to create electroanatomical maps of the LA. This complication should be suspected when attempts to reposition the catheter into another PV are met with resistance. When suspected, it is important to confirm the diagnosis with echocardiography. Although successful freeing of the catheter has been reported with gentle clockwise catheter manipulation and advancing the sheath into the ventricle in two patients, there have also been a number of cases reported in which the mitral valve apparatus and/or papillary muscles are torn during attempts to free the catheter.1263,1264,1268,1269,1396 There have also been several cases reported in which the distal tip of the circular catheter broke off during attempts at catheter removal and had to be subsequently removed either with a snare or with an open surgical procedure.1263,1265,1266 We recommend that if gentle attempts to free the catheter fail, elective surgical removal of the catheter should be performed."}