Straightening Trapped Duodecapolar Catheter Loop in IVC via Contralateral Subclavian Deflectable Catheter

To present a simple, reproducible technique to release inferior vena cava (IVC) loop entrapment of a duodecapolar catheter using contralateral subclavian access and a deflectable ablation catheter.

After a trapped duodecapolar catheter in the IVC, stop traction and confirm the IVC loop using biplane fluoroscopy. Obtain a separate contralateral (left) subclavian venous access with an 8- to 9-F sheath. Advance a deflectable ablation catheter to the IVC via left subclavian access, engage the loop apex, and apply controlled upward traction to straighten the loop. Remove the trapped catheter intact and reverify the ablation endpoints.

Potential pitfalls included the following: misidentifying right atrial vs IVC loops, escalating traction, inadequate subclavian support, and failure to reconfirm cavotricuspid isthmus block/pulmonary vein isolation endpoints.

A deflectable catheter placed using contralateral access site can free IVC loop entrapment rapidly without snares.