Successful removal of a circular mapping catheter which perforated the pulmonary vein during cryoballoon ablation by lateral thoracotomy: a case report

BACKGROUND: Serious complications may occur during cryoballoon ablation (CBA). However, pulmonary vein (PV) perforation by a circular mapping catheter and the strategy for removing the catheter remain poorly understood. CASE SUMMARY: A 40-year-old male presented with palpitations 2 years ago and was diagnosed with paroxysmal atrial fibrillation 5 months ago. He underwent CBA for paroxysmal atrial fibrillation. After isolation of the left PV, a circular mapping catheter was advanced in the right inferior pulmonary vein (RIPV), and single freeze was performed. After isolation of the PV, the catheter tip was immobile and could not be withdrawn with significant resistance. Computed tomography showed that the catheter tip perforated the posterior basal vein (V10) of the RIPV and remained in the right lower lobe, along with intrapulmonary haemorrhage. The patient underwent surgery via right lateral thoracotomy to remove the catheter. The RIPV was peeled to the periphery to expose the V10. The catheter perforated the vessel wall in the middle of the V10 and entered the pulmonary parenchyma. A microincision on the lung parenchyma covering the surface of the catheter tip was performed, and the circular distal portion of the catheter was cut. The entire catheter (i.e. shaft and proximal portion) was successfully removed from the transseptal catheter. DISCUSSION: Surgical approach was performed for the management of PV perforation caused by a circular mapping catheter. This case may assist in troubleshooting and problem-solving in case such an event occurs again during procedures in the future.