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Extraction of radiolucent fractured wire components using intracardiac ultrasound during pulmonary vein isolation procedure  Joseph C. Lee, MD, Robert.

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Presentation on theme: "Extraction of radiolucent fractured wire components using intracardiac ultrasound during pulmonary vein isolation procedure  Joseph C. Lee, MD, Robert."— Presentation transcript:

1 Extraction of radiolucent fractured wire components using intracardiac ultrasound during pulmonary vein isolation procedure  Joseph C. Lee, MD, Robert Gallagher, MD  HeartRhythm Case Reports  DOI: /j.hrcr Copyright © Terms and Conditions

2 Figure 1 Intracardiac ultrasound image of wire fragment from fractured ProTrack wire (Baylis Medical, Toronto, Canada) in the right atrium. This segment was completely radiolucent. The visible sheath next to the fragment is an 8.5F SL1 sheath with alligator forceps for securing the wire. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © Terms and Conditions

3 Figure 2 Same fragment of wire from Figure 1 after removal. The very thin diameter of this stainless steel wire likely explains why it could not be seen with fluoroscopy. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © Terms and Conditions

4 Figure 3 Photographs of a normal ProTrack wire (Baylis Medical, Toronto, Canada) (left), and the fractured ProTrack wire (right). Note extensive unraveling of the distal coil component portion of the wire. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © Terms and Conditions

5 Supplemental Figure 1 ICE imaging of the inferior vena cava junction at the iliac bifurcation, left iliac (above), right iliac (below). The Mobi sheath with wire fragments attached is seen with multiple loops of wire underneath, the sheath is coming from the right iliac vein (below). HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © Terms and Conditions

6 Supplemental Figure 2 Protrack wire construction, a stainless steel shaft with stainless steel coil material wrapping around the shaft. This hybrid construction allows for its soft curled tip to facilitate transseptal passage and prevent loss of left atrial access. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © Terms and Conditions

7 Supplemental Figure 3 Photo of Mobi sheath with ruptured side port after extraction of retained wire fragments. We believe the inflation of the angioplasty balloon within the Mobi sheath likely ruptured this side port but also allowed for the wire to then be removed. The catheter seen in the photo was inserted after removal to make the side port in black more visible. HeartRhythm Case Reports DOI: ( /j.hrcr ) Copyright © Terms and Conditions

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