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The mitral valve complex: A complex trap to be avoided by cardiac electrophysiologists-A systematic review

Hussam Ali1, Ahmad Abdelrady Abdelsalam Farghaly2, Robert H Anderson3

  • 1Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.

Heart Rhythm
|June 16, 2025
PubMed

Insights

Catheter entrapment in the mitral valve complex (MVC) during cardiac procedures is rare but serious. This review highlights common catheter types involved and management strategies, emphasizing prevention during electrophysiological interventions.

Area of Science:

  • Cardiology
  • Interventional Electrophysiology

Background:

  • Catheter entrapment in the mitral valve complex (MVC) is a rare but significant complication during left heart catheterization.
  • Electrophysiological procedures, particularly catheter ablation for atrial tachyarrhythmias, carry a risk of this adverse event.

Purpose of the Study:

  • To systematically review and analyze cases of catheter entrapment within the mitral valve complex during electrophysiological procedures.
  • To identify the types of catheters most frequently entrapped and the circumstances surrounding entrapment.

Main Methods:

  • A systematic review was performed using PubMed and Embase databases.
  • The review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
  • Forty-six cases of catheter entrapment within the MVC were identified and analyzed.

Main Results:

  • Circular mapping catheters were most frequently entrapped (50%), followed by ablation and multispline catheters.
  • Ablation catheter entrapment often occurred during retrograde advancement; multispline catheter entrapment was linked to mechanical valves.
  • Percutaneous management succeeded in 47.8% of cases, with surgery required in 52.2%, including valve surgery in 30.4%.

Conclusions:

  • Catheter entrapment in the MVC is a critical complication requiring careful consideration during electrophysiological procedures.
  • Preventive strategies and awareness are crucial when performing interventions near the mitral valve complex.
  • Both percutaneous and surgical interventions have roles in managing this complication, with significant rates of surgical intervention including valve surgery.

Keywords:
Catheter ablationCatheter entrapmentElectrophysiological proceduresMitral valve complexSystematic review

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