| Summary: | Catheter ablation (CAbl), requiring transseptal puncture, has emerged to a standard procedure in patients (Pts) with symptomatic atrial fibrillation (AF). Frequently a small right to left shunt can be observed with Valsalva maneuvers after the procedure. A recent meta-analysis suggests that migraineurs with aura are more than 4x more likely to have a PFO than the general population. We describe a hitherto unrecognized phenomenon following CAbl of AF (439 consecutive Pts, 1/2015 to 3/2016, mean age 63±11 years, 66.5% male gender). CAbl was performed using radio frequency current (RF, n=260, Navistar Thermocool TM , settings 20watt to 40watt, 43°C) or cryo-energy (CRYO, n=179 paroxysmal AF only, Arctic Front Advance TM , <-40°C to ≥-60°C). CAbl was performed during uninterrupted oral anticoagulation (OAC) with a vitamin K antagonists (n=128, INR >2) or with direct OAC (Dabigatran n=89, Rivaroxaban n=148, Apixaban n=73, Edoxaban n=1). After CAbl Pts underwent continuous ECG-monitoring, a neurologic evaluation followed the procedure immediately and was repeated after 24h. Pts were encouraged to report any complaints. Eight Pts (1.8%) had short lasting neurologic complaints and received, as part of the work-up, cerebral magnetic resonance imaging (MRI). Two Pts with transient neurologic deficits (vertigo n=1, Phenprocoumon, INR 2.4, speech disorders n=1, Rivaroxaban 20mg) had new small ischemic cerebral lesions. All 6 Pts (Dabigatran n=3, Rivaroxaban n=2, Phenprocoumon n=1, INR 2,1, RF n=2, Cryo n=4) with negative MRI had visual disturbances, followed by headache, as typically reported by migraineurs. One patient had a history of migraine with aura, five Pts never before had similar complaints. Pts with visual disturbances and headache continued to have similar complaints during the following 2 weeks. Follow-up of both patients with new ischemic lesions was inconspicuous. Conclusion: Recurrent migraine with visual disturbances occurred after CAbl of AF in about 1.5% of Pts with uninterrupted OAC who never had ...
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