Bilateral occipital lobe infarction with altitudinal field loss following radiofrequency cardiac catheter ablation

Susie T Luu,Celia S Chen,Andrew W Lee

doi:10.1186/1471-2261-10-14

Abstract

BackgroundBilateral stroke following radiofrequency catheter ablation is an unusual complication and may result in bilateral altitudinal visual field defects. Bilateral altitudinal visual field defects usually result from prechiasmal pathology causing damage to both retinas or optic nerves and rarely from bilateral symmetric damage to the post chiasmal visual pathways.Case presentationA 48-year-old man complained of visual disturbance on wakening following radiofrequency catheter ablation. The patient had a CHADS score of 1 pre-operatively and no complications were noted intra-operatively. Examination revealed a bilateral superior altitudinal defect and MRI of the brain showed multifocal areas of infarction predominantly involving the occipital lobes which correlated to with the visual deficits.ConclusionWhile the risk of thromboembolism and perioperative stroke during radiofrequency catheter ablation is small, it is not insignificant.

Highlights

Bilateral stroke following radiofrequency catheter ablation is an unusual complication and may result in bilateral altitudinal visual field defects
Bilateral altitudinal field defects more commonly result from prechiasmal pathologies affecting both retinas or optic nerves rather than processes causing bilateral symmetric damage to the post-chiasmal visual pathways [3]
Case presentation A 48-year-old man underwent percutaneous cathether ablation for atrial fibrillation. Four years previously he had been diagnosed with a dilated cardiomyopathy after

Summary

Background

Radiofrequency catheter ablation is one method of restoring sinus rhythm in patients with atrial fibrillation (AF) [1]. On examination the patient had a visual acuity of 2/200 in both eyes and computerised static perimetry performed day 1 post ablation showed bilateral superior altitudinal field defects (figure 1). A review one week later, showed an improvement in the visual acuity to 20/60 in the right eye and 20/80 in the left eye with a persistent bilateral superior altitudinal field defect. Visual acuity and visual field remained unchanged and the patient continued to have ongoing difficulties with word finding and reading. His atrial fibrillation, was well controlled on medical therapy (warfarin, amidarone, perindopril and metoprolol)

Discussion

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Conclusion

Asirvatham SJ