Association of transseptal punctures with isolated migraine aura in patients undergoing catheter ablation of cardiac arrhythmias

Karuna Chilukuri, Sunil Sinha, Ronald Berger, Joseph E. Marine, Alan Cheng, Saman Nazarian, Daniel Scherr, David Spragg, Hugh Calkins, Charles Henrikson

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Association of Transseptal Punctures with Migraine Aura. Background: Transseptal catheterization (TSC) is performed during catheter ablation involving the lefthand side of the heart. TSC causes a transient iatrogenic atrial septal defect that can predispose patients to migraine episodes. However, isolated migraine aura episodes in patients undergoing TSC have not been described. Methods: Five hundred seventy-one procedures involving TSC were performed over a 3-year duration. Of these, 3 patients presented with visual symptoms in the first month after the procedure. One patient underwent a TSC during catheter ablation of left-sided accessory pathway and 2 patients underwent TSC during catheter ablation of atrial fibrillation. Results: The incidence of migraine aura in this patient population was 0.5%. In the first week after the procedure, all 3 patients experienced transient reversible visual symptoms of scintillating scotoma consistent with migraine aura. None of the patients had an associated headache. The workup for stroke or transient ischemic attack was negative. All the patients recovered completely within 1 hour of symptom onset and did not have any sequelae. Conclusion: This study reports for the first time the incidence and outcomes of isolated migraine aura in patients undergoing electrophysiology procedures involving TSC. For post-TSC patients who present with atypical neurologic symptoms, especially "scintillating scotoma," once transient ischemic attack or other neurologic event has been ruled out, an aura associated with the TSC should be entertained as a possible diagnosis. Electrophysiologists who perform TSC, need to be aware of this phenomenon and can reassure the patients of the transient and benign nature.

Original languageEnglish (US)
Pages (from-to)1227-1230
Number of pages4
JournalJournal of Cardiovascular Electrophysiology
Volume20
Issue number11
DOIs
StatePublished - 2009
Externally publishedYes

Fingerprint

Migraine with Aura
Catheter Ablation
Punctures
Cardiac Arrhythmias
Catheterization
Migraine Disorders
Epilepsy
Scotoma
Transient Ischemic Attack
Atrial Heart Septal Defects
Electrophysiology
Incidence
Neurologic Manifestations
Atrial Fibrillation
Nervous System
Headache

Keywords

  • Catheter ablation
  • Iatrogenic atrial septal defect
  • Migraine aura
  • Scintillating scotoma
  • Stroke
  • Transient ischemic attack
  • Transseptal punctures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Association of transseptal punctures with isolated migraine aura in patients undergoing catheter ablation of cardiac arrhythmias. / Chilukuri, Karuna; Sinha, Sunil; Berger, Ronald; Marine, Joseph E.; Cheng, Alan; Nazarian, Saman; Scherr, Daniel; Spragg, David; Calkins, Hugh; Henrikson, Charles.

In: Journal of Cardiovascular Electrophysiology, Vol. 20, No. 11, 2009, p. 1227-1230.

Research output: Contribution to journalArticle

Chilukuri, Karuna ; Sinha, Sunil ; Berger, Ronald ; Marine, Joseph E. ; Cheng, Alan ; Nazarian, Saman ; Scherr, Daniel ; Spragg, David ; Calkins, Hugh ; Henrikson, Charles. / Association of transseptal punctures with isolated migraine aura in patients undergoing catheter ablation of cardiac arrhythmias. In: Journal of Cardiovascular Electrophysiology. 2009 ; Vol. 20, No. 11. pp. 1227-1230.
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AU - Chilukuri, Karuna

AU - Sinha, Sunil

AU - Berger, Ronald

AU - Marine, Joseph E.

AU - Cheng, Alan

AU - Nazarian, Saman

AU - Scherr, Daniel

AU - Spragg, David

AU - Calkins, Hugh

AU - Henrikson, Charles

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N2 - Association of Transseptal Punctures with Migraine Aura. Background: Transseptal catheterization (TSC) is performed during catheter ablation involving the lefthand side of the heart. TSC causes a transient iatrogenic atrial septal defect that can predispose patients to migraine episodes. However, isolated migraine aura episodes in patients undergoing TSC have not been described. Methods: Five hundred seventy-one procedures involving TSC were performed over a 3-year duration. Of these, 3 patients presented with visual symptoms in the first month after the procedure. One patient underwent a TSC during catheter ablation of left-sided accessory pathway and 2 patients underwent TSC during catheter ablation of atrial fibrillation. Results: The incidence of migraine aura in this patient population was 0.5%. In the first week after the procedure, all 3 patients experienced transient reversible visual symptoms of scintillating scotoma consistent with migraine aura. None of the patients had an associated headache. The workup for stroke or transient ischemic attack was negative. All the patients recovered completely within 1 hour of symptom onset and did not have any sequelae. Conclusion: This study reports for the first time the incidence and outcomes of isolated migraine aura in patients undergoing electrophysiology procedures involving TSC. For post-TSC patients who present with atypical neurologic symptoms, especially "scintillating scotoma," once transient ischemic attack or other neurologic event has been ruled out, an aura associated with the TSC should be entertained as a possible diagnosis. Electrophysiologists who perform TSC, need to be aware of this phenomenon and can reassure the patients of the transient and benign nature.

AB - Association of Transseptal Punctures with Migraine Aura. Background: Transseptal catheterization (TSC) is performed during catheter ablation involving the lefthand side of the heart. TSC causes a transient iatrogenic atrial septal defect that can predispose patients to migraine episodes. However, isolated migraine aura episodes in patients undergoing TSC have not been described. Methods: Five hundred seventy-one procedures involving TSC were performed over a 3-year duration. Of these, 3 patients presented with visual symptoms in the first month after the procedure. One patient underwent a TSC during catheter ablation of left-sided accessory pathway and 2 patients underwent TSC during catheter ablation of atrial fibrillation. Results: The incidence of migraine aura in this patient population was 0.5%. In the first week after the procedure, all 3 patients experienced transient reversible visual symptoms of scintillating scotoma consistent with migraine aura. None of the patients had an associated headache. The workup for stroke or transient ischemic attack was negative. All the patients recovered completely within 1 hour of symptom onset and did not have any sequelae. Conclusion: This study reports for the first time the incidence and outcomes of isolated migraine aura in patients undergoing electrophysiology procedures involving TSC. For post-TSC patients who present with atypical neurologic symptoms, especially "scintillating scotoma," once transient ischemic attack or other neurologic event has been ruled out, an aura associated with the TSC should be entertained as a possible diagnosis. Electrophysiologists who perform TSC, need to be aware of this phenomenon and can reassure the patients of the transient and benign nature.

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