5.1 Ischemic complication during RFCA
Together with atrio-esophageal fistula, peri-procedural ischemic
complication is most dreaded complication in AF patients undergoing
RFCA.15 Since patients
are in deep sedation or under general anesthesia, they cannot complain
any neurologic symptoms when their cerebral arteries are occluded by
thrombus or char. It takes several hours to complete the procedure and
to recover from sedation or general anesthesia. Therefore, immediate
revascularization was often not feasible. Furthermore, char formation
during radiofrequency energy delivery makes harder thrombus material
which makes revascularization therapy even more difficult. Although
massive thrombus and char embolization during RFCA is a rare event, it
is usually unrecoverable once occurred.
In our registry, five patient had significant neurologic sequelae
defined as permanent neurologic symptoms limiting their normal daily
life or occupation. Making ischemic stroke during treatment process of
AF is an irony and 0.16% (5 among 3,120 patients) risk of having
significant neurologic sequelae cannot be ignored.