Novel percutaneous retrieval of a self-entangled decapolar catheter using a deflectable sheath and guidewire counter-traction

Catheter entanglement is an uncommon but potentially serious complication during electrophysiological procedures. This is a rare case of self-entanglement of a diagnostic decapolar catheter during cryoablation for persistent atrial fibrillation. A 61-year-old man underwent catheter-based rhythm control therapy under conscious sedation. During coronary sinus cannulation, the catheter unexpectedly prolapsed and formed a self-loop within the right atrium. Repeated manipulation and traction resulted in progressive tightening of the loop around the Eustachian valve region and adjacent right atrial structures, making conventional withdrawal unsuccessful. Inferior vena cava venography demonstrated marked venous tortuosity, which likely impaired torque transmission and contributed to uncontrolled catheter rebound and looping. A bailout retrieval strategy using a right internal jugular approach, an Attain™ deflectable delivery system, guidewire-assisted loop stabilization, and EN Snare^® counter-traction successfully released the entrapped catheter without surgical intervention or structural injury. This case highlights a reproducible percutaneous retrieval strategy for complex right atrial catheter entanglement.