Abstract 11738: Migraine With Aura, an Undescribed Complication of Catheter Ablation of Atrial Fibrillation

Abstract

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 migraine before. It seems likely that the mechanism of visual disturbances followed by headache after CAbl of AF resembles the mechanism of migraine in patients with PFO. It is unknown whether migraine may become a chronic condition after CAbl of AF.