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

Catheter entrapment within the mitral valve complex (MVC) is a rare but serious complication during left heart catheterization. A systematic review—the first on this topic—was conducted using PubMed and Embase databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to identify cases of catheter entrapment within the MVC during electrophysiological procedures. Forty-six patients predominantly undergoing catheter ablation of atrial tachyarrhythmias (71.7%) were included. Circular mapping catheters were the most frequently entrapped materials (50%), followed by ablation and multispline catheters. Ablation catheters were mostly entrapped when advanced retrogradely, while multispline catheter entrapment was exclusively observed in patients with mechanical valves. Percutaneous management was successful in 47.8% of patients, one-third of whom required retrieval of embolized catheter segments. Surgery was necessary in 52.2% of patients, including valve surgery in 30.4%. Awareness of this potential complication and application of preventive strategies are essential when mapping or ablating adjacent to the MVC.