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Case Report
Early catheter-associated thrombus formation and migration during pulmonary vein isolation: an approach to rule out stroke and carry on the procedure
1 Department of Clinical Medicine, Health Science Center, Federal University of Santa Maria, Santa Maria, Brazil
2 Postgraduate Program in Health Science, Federal University of Santa Maria, Santa Maria, Brazil
3 Electrophysiology Division, Heart Institute (ICOR) of Santa Maria, Santa Maria, Brazil
Address correspondence to:
Diego Chemello
MD, ScD, Universidade Federal de Santa Maria (UFSM), Cento de Ciências da Saúde – Depto. de Clínica Médica, Av. Roraima, 1000. Prédio 26. Cidade Universitária. Bairro Camobi. Santa Maria, RS, CEP: 97105-900,
Brazil
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Article ID: 100991Z01DC2019
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Chemello D, Marquesan LQ. Early catheterassociated thrombus formation and migration during pulmonary vein isolation: an approach to rule out stroke and carry on the procedure. Int J Case Rep Images 2019;10:100991Z01DC2019.ABSTRACT
Introduction: Catheter ablation is a wellknown treatment strategy for patients with symptomatic atrial fibrillation. Despite the benefits in controlling symptoms, the procedure can be associated with complication. Among the most threatening complications, thrombus formation has great importance, since it´s associated with embolic events. In this setting, sheath and catheter associated thrombi have become increasingly identified with the use of intracardiac echocardiography. Despite anticoagulation, these thrombi are found in 10% of cases, with clinical complications in up to 1%. Management of these thrombi includes withdrawal of the sheath and catheter when the thrombi are left to be firmly attached, thrombus aspirations and local thrombolysis.
Case Report: We describe a case of early sheath thrombus formation after the first transeptal puncture during atrial fibrillation catheter ablation. This was followed by thrombus detachment and migration from the sheath located in the left atrium. Instead of aborting the procedure, which is the standard approach in such situation, patient had anesthesia reversion, neurologic evaluation and procedure resumption without complications.
Conclusion: The routine use of intracardiac echocardiography has contributed to detection of early complications during atrial fibrillation catheter ablation, like thrombus formation. Correct anticoagulation during the procedure is essential, as well as the continuous monitoring of thrombus formation. This is the first case report of temporary general anesthesia reversion after LA thrombus migration to rule out stroke.
Keywords: Atrial fibrillation, Catheter ablation, Pulmonary veins, Thrombosis
SUPPORTING INFORMATION
Author Contributions
Diego Chemello - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Luana Quintana Marquesan - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Diego Chemello et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
