Association of Transseptal Punctures with Isolated Migraine Aura in Patients Undergoing Catheter Ablation of Cardiac Arrhythmias

  1. KARUNA CHILUKURI M.D.1,
  2. SUNIL SINHA M.D.1,
  3. RONALD BERGER M.D., Ph.D.1,
  4. JOSEPH E. MARINE M.D.1,
  5. ALAN CHENG M.D.1,
  6. SAMAN NAZARIAN M.D.1,
  7. DANIEL SCHERR M.D.1,2,
  8. DAVID SPRAGG M.D.1,
  9. HUGH CALKINS M.D.1,
  10. CHARLES A. HENRIKSON M.D.1

Article first published online: 26 JUN 2009

DOI: 10.1111/j.1540-8167.2009.01525.x

Issue

Journal of Cardiovascular Electrophysiology

Journal of Cardiovascular Electrophysiology

Volume 20, Issue 11, pages 1227–1230, November 2009

Additional Information

How to Cite

CHILUKURI, K., SINHA, S., BERGER, R., MARINE, J. E., CHENG, A., NAZARIAN, S., SCHERR, D., SPRAGG, D., CALKINS, H. and HENRIKSON, C. A. (2009), Association of Transseptal Punctures with Isolated Migraine Aura in Patients Undergoing Catheter Ablation of Cardiac Arrhythmias. Journal of Cardiovascular Electrophysiology, 20: 1227–1230. doi: 10.1111/j.1540-8167.2009.01525.x

Author Information

  1. 1

    Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

  2. 2

    Department of Medicine, Division of Cardiology, Medical University of Graz, Styria, Austria

*Address for correspondence: Charles A. Henrikson, M.D., The Johns Hopkins Hospital, 600 North Wolfe Street, Carnegie 592, Baltimore, MD 21287-0409, USA. Fax: 410-955-0223; E-mail: chenriks@jhmi.edu

Publication History

  1. Issue published online: 30 OCT 2009
  2. Article first published online: 26 JUN 2009
  3. Manuscript received 26 March 2009; Revised manuscript received 18 April 2009; Accepted for publication 27 April 2009.

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Keywords:

  • transseptal punctures;
  • migraine aura;
  • catheter ablation;
  • iatrogenic atrial septal defect;
  • transient ischemic attack;
  • stroke;
  • scintillating scotoma

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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