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Cardioembolic stroke following a fractured transseptal wire

Year: 2012

Type: article

Abstract: A 66-year-old right-handed man with a history of atrial fibrillation was admitted for an elective radiofrequency ablation procedure. During this procedure, a left atrial tachycardia was identified and ablated without interrupting anticoagulation, and this was complicated by a groin hematoma. The morning following the procedure, the patient awoke with tongue heaviness and mild confusion. During a groin ultrasound, he experienced the acute onset of flushing, diaphoresis and blurred vision, then transiently lost consciousness. Upon regaining consciousness, he was found to be more dysarthric and confused. He underwent a stat CT Angiogram of the head and neck, which revealed no acute abnormalities. MRI brain showed multiple, embolic-appearing infarcts with unremarkable vasculature (Figure 1). A trans-thoracic echocardiogram did not reveal any thrombus. The patient also underwent a trans-esophageal echocardiogram that did not show any evidence of cardiac sources of emboli such as thrombi in the left atrial appendage or any aortic plaques. However, a chest X-ray revealed a long, thin, radiopaque foreign body in the left upper lung field, raising the possibility that a portion of the balance heavy weight (BHW) wire used for stability during transseptal puncture had fractured and remained (Figure 2), and thromboemboli were due to the nidus created by the fractured and dislodged guide wire. A CT scan confirmed the presence of a guide wire looped in the left ventricle, with one end lodged within the superior pulmonary vein and the other in the left inferior pulmonary vein. The 12 inches of BHW wire were later extracted without further sequelae. He recovered well from his neurological deficits and was discharged on anticoagulation.

Source: QJM

DOI: 10.1093/qjmed/hcs092

Authors: S. Srinivasan, A. Mahta, S. Kesari

Institutions: Brigham and Women's Hospital, University of California San Diego, Moores Cancer Center

Language: English

Topic: Cardiac Arrhythmias and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funder: National Cancer Institute