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Case Reports
. 2023 May 3;7(5):ytad226.
doi: 10.1093/ehjcr/ytad226. eCollection 2023 May.

MitraClip detachment after electrical cardioversion: a case report

Oren Yagel  1 , David Planer  1 , Yair Elitzur  1 , Ronen Be'eri  1 , Gabby Elbaz-Greener  1
Affiliations
Case Reports

MitraClip detachment after electrical cardioversion: a case report

Oren Yagel et al. Eur Heart J Case Rep. .

Abstract

Background: Transcatheter edge-to-edge repair (TEER) repair is a minimally invasive procedure used for patients with severe mitral regurgitation (MR). Cardioversion is indicated for haemodynamically unstable patients with narrow complex tachycardia and is generally considered safe post-mitral clip. We present a patient who underwent cardioversion post-TEER with a single leaflet detachment (SLD).

Case summary: An 86-year-old female with severe MR underwent TEER with a MitraClip that reduced MR severity to mild. During the procedure, the patient experienced tachycardia, and cardioversion was performed successfully. However, immediately after the cardioversion, the operators noticed recurrent severe MR with a posterior leaflet clip detachment. Deployment of a new clip adjacent to the detached one was obtained.

Discussion: Transcatheter edge-to-edge repair is a well-established method for treating severe MR in patients who are not suitable for surgical intervention. However, complications can arise during or after the procedure, such as clip detachment as in this case. Several mechanisms can explain SLD. We presumed that in the current case, immediately after cardioversion, there was an acute (post-pause) increase in left ventricle end-diastolic volume and thus in the left ventricle systolic volume with more vigorous contraction, possibly pulling apart the leaflets and detaching the freshly applied TEER device. This is the first report of SLD related to electrical cardioversion after TEER. Even though electrical cardioversion is considered safe, SLD can occur in this setting.

Keywords: Cardioversion; Case report; Clip detachment; Edge-to-edge mitral repair; Mitral clip; Mitral regurgitation.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Echocardiogram—parasternal long-axis view—severe mitral regurgitation.
Figure 2
Figure 2
Electrocardiogram—regular wide complex tachycardia.
Figure 3
Figure 3
Echocardiogram—post-clip insertion.
Figure 4
Figure 4
Echocardiogram—posterior leaflet detachment.
Figure 5
Figure 5
Echocardiogram—post second clip insertion.
See this image and copyright information in PMC

References

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