Paradoxical Brain Emboli Related to Heparin-Induced Thrombocytopenia after Catheter Ablation
Ryo Itabashi1, Yukako Yazawa1, Kenta Kawata1
1Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan.
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.
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