Targeted Aspiration of Localized Left Atrial Appendage Air Entrapment During Atrial Fibrillation Ablation.

BACKGROUND: Air embolism is a rare but potentially catastrophic complication of atrial fibrillation ablation, and evidence guiding management of localized left atrial appendage (LAA) air entrapment is limited. CASE SUMMARY: A 69-year-old woman undergoing ablation for persistent atrial fibrillation developed localized LAA air entrapment when incorrect positioning of a 3-way stopcock during deairing allowed air to enter the ablation-catheter irrigation circuit. Fluoroscopy prompted immediate cessation of ablation. Stepwise aspiration using the indwelling ablation catheter, a larger-bore sheath near the LAA ostium, and targeted catheter aspiration of residual distal air resulted in disappearance of the visible air shadow. Ablation was completed without further acute complications. DISCUSSION: This case illustrates an anatomy-oriented aspiration strategy for air confined within an angulated LAA recess. TAKE-HOME MESSAGES: Stopcock position and irrigation flow should be verified during deairing. Prompt recognition and cautious stepwise aspiration may facilitate management in selected cases.