Fracture and retrieval of an Achieve circular mapping catheter in and from a pulmonary vein during cryoballoon ablation for atrial fibrillation

Case report A 48-year-old man underwent cryoballoon ablation for symptomatic recurrent drug refractory paroxysmal AF. He was previously treated with flecainide, but it was discontinued because of inefficacy and adverse effects. Other than AF, his medical history was pertinent only for Bright disease as a child and cervical vertebral fusion. In the electrophysiology laboratory, vascular access was obtained via the right internal jugular (6 French), right femoral (Medtronic Flexcath Advance LA 15 French), and left femoral veins (7 and 9 French sheaths). A Medtronic 12F FlexCath steerable sheath was used to cross the atrial septum under guidance with a Siemens Acuson intracardiac ultrasound probe. A 20-mm Achieve circular mapping catheter and a Arctic Front Advance cryoballoon (28 mm) catheter were advanced into the left atrium via the transseptal sheath. The patient was heparinized to achieve an activated clotting time of 4300 seconds throughout the catheter ablation procedure. Additional diagnostic electrophysiology catheters were positioned in the high right atrium, right ventricular apex, coronary sinus, and His bundle region for pacing and recording. Electrophysiologic testing was then performed. A shell of the pulmonary veins and the left atrium was made using the Endocardial Solutions EnSite 3-dimensional