{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:00:14Z","timestamp":1770055214349,"version":"3.49.0"},"reference-count":5,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Temporary transvenous pacing in patients with permanent atrial fibrillation and significant tricuspid valve disease is technically challenging, especially in the absence of fluoroscopic guidance. Catheter looping and knot formation are rare but potentially hazardous complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 82-year-old woman with permanent atrial fibrillation and severe mitral and tricuspid valve regurgitation presented with complete atrioventricular block and a ventricular escape rhythm at 28\u2005bpm. A temporary transvenous pacing catheter inserted via the right internal jugular vein failed to achieve consistent ventricular capture and became entrapped at 45\u2005cm, forming a knot near the venous introducer. Given the patient's frailty and high surgical risk, a multidisciplinary team opted for a fully percutaneous strategy for removal. After definitive pacemaker implantation, the knotted catheter was successfully retrieved using a stepwise approach: engagement of the loop with a deflectable ablation catheter, externalization through a femoral sheath, and extraction using a 13-F dilator sheath to minimize venous trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights procedural pitfalls during emergency temporary pacing without fluoroscopy and illustrates a safe, creative percutaneous solution for knot retrieval using tools familiar to electrophysiology and lead extraction operators.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1756548","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T06:31:14Z","timestamp":1770013874000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A sailor's knot in the heart: percutaneous retrieval of a knotted temporary pacing lead"],"prefix":"10.3389","volume":"13","author":[{"given":"Roberto","family":"Scacciavillani","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]},{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Filomia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]},{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Pinnacchio","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]},{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluigi","family":"Bencardino","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]},{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Sanna","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]},{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gemma","family":"Pelargonio","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS","place":["Rome, Italy"]},{"name":"Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1053\/ejvs.2001.1591","article-title":"Removal of knotted intravascular devices: case report and review of the literature","volume":"23","author":"Karanikas","year":"2002","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1510","DOI":"10.1016\/j.jcin.2016.04.048","article-title":"Unraveling a knot in the heart: tackling an unanticipated complication","volume":"9","author":"Sasikumar","year":"2016","journal-title":"JACC Cardiovasc Interv"},{"key":"B3","doi-asserted-by":"publisher","first-page":"ytae623","DOI":"10.1093\/ehjcr\/ytae623","article-title":"A rare complication of intracardiac double knotting of a temporary pacemaker lead during bedside insertion: a case report","volume":"8","author":"Dattagupta","year":"2024","journal-title":"Eur Heart J Case Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.ipej.2018.02.004","article-title":"Successful percutaneous retrieval of unusually knotted temporary pacemaker lead","volume":"18","author":"Nawale","year":"2018","journal-title":"Indian Pacing Electrophysiol J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1016\/j.jaccas.2020.06.024","article-title":"What knot to do: retrieval of a kinked and trapped coronary catheter","volume":"2","author":"Malik","year":"2020","journal-title":"JACC Case Rep"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1756548\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T06:31:14Z","timestamp":1770013874000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1756548\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":5,"alternative-id":["10.3389\/fcvm.2026.1756548"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1756548","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]},"article-number":"1756548"}}