Bilateral occipital lobe infarction with altitudinal field loss following radiofrequency cardiac catheter ablation

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Abstract

Background

Bilateral stroke following radiofrequency catheter ablation is an unusual complication and may result in bilateral altitudinal visual field defects. Bilateral altitudinal visual field defects usually result from prechiasmal pathology causing damage to both retinas or optic nerves and rarely from bilateral symmetric damage to the post chiasmal visual pathways.

Case presentation

A 48-year-old man complained of visual disturbance on wakening following radiofrequency catheter ablation. The patient had a CHADS score of 1 pre-operatively and no complications were noted intra-operatively. Examination revealed a bilateral superior altitudinal defect and MRI of the brain showed multifocal areas of infarction predominantly involving the occipital lobes which correlated to with the visual deficits.

Conclusion

While the risk of thromboembolism and perioperative stroke during radiofrequency catheter ablation is small, it is not insignificant.

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Most cited references 5

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Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.

Wyn Davies, Riccardo Cappato, You Wang Kim … (2005)

The purpose of this study was to conduct a worldwide survey investigating the methods, efficacy, and safety of catheter ablation (CA) of atrial fibrillation (AF). A detailed questionnaire was sent to 777 centers worldwide. Data relevant to the study purpose were collected from 181 centers, of which 100 had ongoing programs on CA of AF between 1995 and 2002. The number of patients undergoing this procedure increased from 18 in 1995 to 5050 in 2002. The median number of procedures per center was 37.5 (range, 1 to 600). Paroxysmal AF, persistent AF, and permanent AF were the indicated arrhythmias in 100.0%, 53.0%, and 20.0% of responding centers, respectively. The most commonly used techniques were right atrial compartmentalization between 1995 and 1997, ablation of the triggering focus in 1998 and 1999, and electrical disconnection of multiple pulmonary veins between 2000 and 2002. Of 8745 patients completing the CA protocol in 90 centers, of whom 2389 (27.3%) required >1 procedure, 4550 (52.0%; range among centers, 14.5% to 76.5%) became asymptomatic without drugs and another 2094 (23.9%; range among centers, 8.8% to 50.3%) became asymptomatic in the presence of formerly ineffective antiarrhythmic drugs over an 11.6+/-7.7-month follow-up period. At least 1 major complication was reported in 524 patients (6.0%). The findings of this survey provide a picture of the variable and evolving methods, efficacy, and safety of CA for AF as practiced in a large number of centers worldwide and may serve as a guide to clinicians considering therapeutic options in patients suffering from this arrhythmia.

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Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation.

Riccardo Cappato, Hugh Calkins, Shih-Ann Chen … (2009)

The purpose of this study was to provide a systematic multicenter survey on the incidence and causes of death occurring in the setting of or as a consequence of catheter ablation (CA) of atrial fibrillation (AF). CA of AF is considered to be generally safe. However, serious complications, including death, have been reported. Using a retrospective case series, data relevant to the incidence and cause of intra- and post-procedural death occurring in patients undergoing CA of AF between 1995 and 2006 were collected from 162 of 546 identified centers worldwide. Thirty-two deaths (0.98 per 1,000 patients) were reported during 45,115 procedures in 32,569 patients. Causes of deaths included tamponade in 8 patients (1 later than 30 days), stroke in 5 patients (2 later than 30 days), atrioesophageal fistula in 5 patients, and massive pneumonia in 2 patients. Myocardial infarction, intractable torsades de pointes, septicemia, sudden respiratory arrest, extrapericardial pulmonary vein (PV) perforation, occlusion of both lateral PVs, hemothorax, and anaphylaxis were reported to be responsible for 1 death each, while asphyxia from tracheal compression secondary to subclavian hematoma, intracranial bleeding, acute respiratory distress syndrome, and esophageal perforation from an intraoperative transesophageal echocardiographic probe were causes of 1 late death each. Death is a complication of CA of AF, occurring in 1 of 1,000 patients. Knowledge of possible precipitating causes is key to operators and needs to be considered during decision making with patients.

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Risk of thromboembolic events after percutaneous left atrial radiofrequency ablation of atrial fibrillation.

Eric Good, David Tschopp, Mehmet Ozaydin … (2006)

In patients with atrial fibrillation (AF), the risk of thromboembolic events (TEs) is variable and is influenced by the presence and number of comorbid conditions. The effect of percutaneous left atrial radiofrequency ablation (LARFA) of AF on the risk of TEs is unclear. LARFA was performed in 755 consecutive patients with paroxysmal (n = 490) or chronic (n = 265) AF. Four hundred eleven patients (56%) had > or = 1 risk factor for stroke. All patients were anticoagulated with warfarin for > or = 3 months after LARFA. A TE occurred in 7 patients (0.9%) within 2 weeks of LARFA. A late TE occurred 6 to 10 months after ablation in 2 patients (0.2%), 1 of whom still had AF, despite therapeutic anticoagulation in both. Among 522 patients who remained in sinus rhythm after LARFA, warfarin was discontinued in 79% of 256 patients without risk factors and in 68% of 266 patients with > or = 1 risk factor. Patients older than 65 years or with a history of stroke were more likely to remain anticoagulated despite a successful outcome from LARFA. None of the patients in whom anticoagulation was discontinued had a TE during 25 +/- 8 months of follow-up. The risk of a TE after LARFA is 1.1%, with most events occurring within 2 weeks after the procedure. Discontinuation of anticoagulant therapy appears to be safe after successful LARFA, both in patients without risk factors for stroke and in patients with risk factors other than age > 65 years and history of stroke. Sufficient safety data are as yet unavailable to support discontinuation of anticoagulation in patients older than 65 years or with a history of stroke.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Cardiovasc Disord

Title: BMC Cardiovascular Disorders

Publisher: BioMed Central

ISSN (Electronic): 1471-2261

Publication date Collection: 2010

Publication date (Electronic): 17 March 2010

Volume: 10

Page: 14

Affiliations

[1 ]South Australian Institute of Ophthalmology, Discipline of Ophthalmology and Visual Sciences, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia

[2 ]Flinders Comprehensive Stroke Centre Medical Centre and Flinders University, Bedford Pk, Adelaide, South Australia, Australia

[3 ]Department of Ophthalmology, Flinders Medical Centre and Flinders University, Bedford Pk, Adelaide, South Australia, Australia

Article

Publisher ID: 1471-2261-10-14

DOI: 10.1186/1471-2261-10-14

PMC ID: 2845548

PubMed ID: 20236547

SO-VID: b8eb5035-f01b-486a-a44b-21ebf77b2f13

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bilateral occipital lobe infarction with altitudinal field loss following radiofrequency cardiac catheter ablation

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Abstract

Background

Case presentation

Conclusion

Related collections

Karger: Neurology and Neuroscience

Most cited references 5

Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.

Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation.

Risk of thromboembolic events after percutaneous left atrial radiofrequency ablation of atrial fibrillation.

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