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.