title: Paradoxical Brain Emboli Related to Heparin-Induced Thrombocytopenia after Catheter Ablation.
abstract: BACKGROUND
  Thromboembolism associated with catheter ablation of atrial fibrillation has been considered to be derived from catheters, ablation sites, or a left atrial appendage. Paradoxical brain embolism due to iatrogenic shunt after catheter ablation has yet to be described.
  
  
  METHODS
  We described a patient with atrial fibrillation who developed acute ischemic stroke while coughing 36 hours after successful catheter ablation. He had venous thrombosis due to heparin-induced thrombocytopenia and a right-to-left shunt, likely due to a trans-septal puncture during catheter ablation.
  
  
  RESULTS
  The final diagnosis was paradoxical brain embolism associated with heparin-induced thrombocytopenia.
  
  
  CONCLUSIONS
  In addition to anticoagulation, we should pay attention to deep venous thrombosis including preventive intermittent compression for high-risk patients to reduce the risk of stroke after catheter ablation.
authors.affiliation: Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan. Electronic address: ritabash@kohnan-sendai.or.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Itabashi
authors.affiliation: Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan.
authors.forename: Yukako
authors.initials: Y
authors.lastname: Yazawa
authors.affiliation: Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan.
authors.forename: Kenta
authors.initials: K
authors.lastname: Kawata
authors.affiliation: Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Shigehatake
authors.affiliation: Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan.
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Yang
authors.affiliation: Division of Cardiology, Cardiovascular Center, Sendai Kousei Hospital, Sendai, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Otomo
authors.affiliation: Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Furui
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects*; D019320:Embolism, Paradoxical / Q000150:complications*; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D005343:Fibrinolytic Agents; D006493:Heparin
keywords: Stroke; catheter ablation; heparin-induced thrombocytopenia; paradoxical brain emboli; venous thrombosis