Catheter ablation (CA) was found to outperform antiarrhythmic drug therapy (AAD), and it is a key treatment for rhythm control for patients with symptomatic atrial fibrillation (AF). Nevertheless, the procedure’s effectiveness is limited by recurrence rates. Identifying determinants of effective ablation is critical for optimizing patient selection, operative results, and long-term rhythm management strategies. In this state-of-the-art review, we have comprehensively discussed the various factors that can determine the recurrence of AF after a successful CA.

Central venous port-a-catheters play a pivotal role in various medical procedures, yet they are associated with a spectrum of complications. Catheter fracture with cardiac migration is a rare complication, occurring in less than 1% of patients. Although not very common, it can cause severe issues, necessitating fragment removal. We present a case of spontaneous mediport fracture and migration in a patient with a history of Hodgkin's lymphoma and prior chemotherapy. He presented with nausea, vomiting, and tachycardia. Further evaluation revealed elevated total leukocyte count and labs consistent with diabetic ketoacidosis. He was diagnosed with new-onset diabetes mellitus. Imaging studies confirmed the presence of the fragmented catheter within the right ventricle. Although telemetry monitoring and electrocardiogram (EKG) did not detect arrhythmias, interventional radiology successfully removed the critical fragment from the right ventricle while leaving two smaller non-intravascular fragments in the neck. This case underscores the importance of early identification and interdisciplinary collaboration in managing port catheter fractures and migrations, even in the absence of typical symptoms.