Details of the patient who developed a thromboembolic
event without TEE at repeat ablation
A 66-year-old man taking warfarin underwent radiofrequency ablation for
persistent AF. Repeat ablation was planned 85 days after the first
session due to the frequent occurrence of intermittent AF. The
CHADS2 and CHA2DS2-VASc
scores were 2 and 3, and LVEF and LAD were 57% and 50.6 mm,
respectively. Warfarin was continued after the first session and was
uninterruptedly administered in the repeat session. The patient did not
undergo TEE, but contrast-enhanced CT was performed the day before the
procedure and the absence of thrombi in the LA and LAA was confirmed.
Three days after the ablation, the patient complained of dysarthria and
vomiting. Head magnetic resonance imaging demonstrated an acute
infarction of the basilar artery. The prothrombin international
normalized ratio was 2.23 the day before the procedure, but it decreased
to 1.34 at the time of stroke. Subsequent emergency angiography and
successful catheter thrombectomy resulted in full recovery. In this
case, we concluded that the thrombi which caused the stroke may have
developed after the ablation procedure. Extensive radiofrequency
ablation under the post-procedure therapeutic range of warfarin may have
been the cause of the event.