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


CONCLUSIONS
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.
Chilukuri
Karuna
K
Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0409, USA.
Sinha
Sunil
S
Berger
Ronald
R
Marine
Joseph E
JE
Cheng
Alan
A
Nazarian
Saman
S
Scherr
Daniel
D
Spragg
David
D
Calkins
Hugh
H
Henrikson
Charles A
CA
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland / Q000453:epidemiology; D020325:Migraine with Aura / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D011677:Punctures / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors