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.