Case Report| Volume 24, ISSUE 8, e219-e221, August 2015

Paradoxical Brain Emboli Related to Heparin-Induced Thrombocytopenia after Catheter Ablation


      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.


      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.


      The final diagnosis was paradoxical brain embolism associated with heparin-induced thrombocytopenia.


      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.

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        • Calkins H.
        • Kuck K.H.
        • Cappato R.
        • et al.
        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
        • Lo G.K.
        • Juhl D.
        • Warkentin T.E.
        • et al.
        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
        • Yasaka M.
        • Otsubo R.
        • Oe H.
        • Minematsu K.
        Is stroke a paradoxical embolism in patients with patent foramen ovale?.
        Intern Med. 2005; 44: 434-438
        • Hammerstingl C.
        • Lickfett L.
        • Jeong K.M.
        • et al.
        Persistence of iatrogenic atrial septal defect after pulmonary vein isolation: an underestimated risk ?.
        Am Heart J. 2006; 152: 362.e1-362.e5