title: An unusual complication of atrial fibrillation ablation: case report.
abstract: The authors report a complication of catheter ablation that, to their knowledge, has never been previously reported. A 63-year-old man had undergone successful transvenous catheter thermoablation for atrial fibrillation. The patient remained well until 3 days prior to further admission when he noticed itching in the right frontal area of his scalp. On palpating his scalp, he discovered a metallic body projecting out of it and he proceeded to extract 20 cm of wire from his head. The following day a progressive left hemiplegia developed, and the patient experienced a deteriorating level of consciousness. A CT scan of the brain showed a right frontotemporal intraparenchymal hemorrhage and revealed a metallic structure in the middle of the hematoma. The hematoma was evacuated and a decompressive craniotomy was performed. The guidewire was identified, but it was only possible to extract part of it. It was covered by fibrous tissue, secondary to inflammatory reaction. To the authors' knowledge, this is the first report of guidewire-induced brain hemorrhage. The guidewire apparently had not been removed and had spontaneously migrated from the heart to the brain and beyond to the scalp where it then exited the patient's head. The patient had been well before he attempted to pull out the wire. Earlier identification of the iatrogenic complication of a retained guidewire might have prevented the fatal outcome in this case.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Mentor
authors.initials: M
authors.lastname: Petrela
authors.affiliation: Radiology, University Hospital Centre "Mother Teresa," Tirana, Albania.
authors.forename: Arben
authors.initials: A
authors.lastname: Rroji
authors.affiliation: Radiology, University Hospital Centre "Mother Teresa," Tirana, Albania.
authors.forename: Eugen
authors.initials: E
authors.lastname: Enesi
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Artur
authors.initials: A
authors.lastname: Xhumari
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Artid
authors.initials: A
authors.lastname: Lame
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation*; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017809:Fatal Outcome; D005548:Foreign-Body Migration / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged
keywords: DS = digital subtraction; atrial fibrillation; guidewire; interventional neurosurgery; intracerebral hemorrhage