Background
Thromboembolism associated with catheter ablation of atrial fibrillation has been
considered to be derived from catheters, ablation sites, or a left atrial appendage.
Paradoxical brain embolism due to iatrogenic shunt after catheter ablation has yet
to be described.
Methods
We described a patient with atrial fibrillation who developed acute ischemic stroke
while coughing 36 hours after successful catheter ablation. He had venous thrombosis
due to heparin-induced thrombocytopenia and a right-to-left shunt, likely due to a
trans-septal puncture during catheter ablation.
Results
The final diagnosis was paradoxical brain embolism associated with heparin-induced
thrombocytopenia.
Conclusions
In addition to anticoagulation, we should pay attention to deep venous thrombosis
including preventive intermittent compression for high-risk patients to reduce the
risk of stroke after catheter ablation.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society.Heart Rhythm. 2012; 9: 632-696
- Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin–induced thrombocytopenia in two clinical settings.J Thromb Haemost. 2006; 4: 759-765
- Is stroke a paradoxical embolism in patients with patent foramen ovale?.Intern Med. 2005; 44: 434-438
- Persistence of iatrogenic atrial septal defect after pulmonary vein isolation: an underestimated risk ?.Am Heart J. 2006; 152: 362.e1-362.e5
Article info
Publication history
Published online: May 13, 2015
Accepted:
April 14,
2015
Received in revised form:
April 6,
2015
Received:
February 23,
2015
Footnotes
There are no sources of funding.
R.I. received honoraria of oral speaker from Tanabe Mitsubishi Pharma and received funding for a trip from Stryker Japan. Y.Y. received funding for a trip from Stryker Japan. E.F. received honoraria of oral speaker from Tanabe Mitsubishi Pharma and Daiichi Sankyo. K.K., Y.S., S.Y., and K.O. report no disclosures.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.021
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
