Migraines post ablation

Long time no post for me.

I'd been managing the beast with magnesium etc. pretty well up until last summer, I went from one episode every 12 weeks or so to one every 3 weeks so made an appointment with my cardiologist who suggested I might consider ablation. He referred me to the EP that had originally performed my previous ablation for Atrial Tachycardia eight years ago. I met with the registrar back in January this year and he suggested that I would be a good candidate for ablation and after confirming with the consultant EP, I was booked in for the end of February.

The ablation went well and I was back on the ward within a couple of hours, everything felt good apart from a really bad headache which continued for the next 30 hours (it might have been longer but went to sleep at home with the headache and awoke clear headed the next morning) during the night after the ablation I was struggling to piece words together in conversation with the nurses and was slurring my words. A doctor came to speak with me, ran the usual tests to rule out stroke and suggested it was probably due to my lack of fluids because of my ablation being moved from AM to PM and not being able to drink.

I was discharged around lunch time and over the next week or so I was experiencing migraine symptoms but not always ending with a headache, I was having visual disturbances a couple of times a day with the most frightening being one episode which consisted of strange deja vu images flashing before my eyes as if I was dreaming whilst conscious. I had an appointment with my cardiologist booked soon after and spoke with him about the migraines, he was very interested and told me about research that pointed to post AF ablation migraines, he mentioned that the research suggested a possibility of minute amounts of 'dirty' blood leaking through the hole in the septum that the catheter breaks through to get to the left atrium and that this unclean blood travels through the brain causing the visual disturbances.

Has anyone else on the forum that has had ablation ever experienced post procedure migraines?

HI ROB,

There has been some issues reported not commonly, but it does happen with mostly transient migraine aura symptoms post AF ablation .. or any left sided procedure after a transeptal puncture. Like your cardio noted with his somewhat loose description of 'dirty blood', it may be from atrial septal hole from the picture that has not sealed over yet. Or perhaps was made a bit too wide to begin with.

Do you know if you had one or two transeptal punctures?? sometimes an EP will use a larger single sheath doing a single puncture thinking that is better and then he or she jambs both the ablation catheter and the lasso mapping catheter through this larger single sheath though a larger single hole. However, the big disadvantage that can happen here is that they lose the positioning flexibility of doing a dual transeptal puncture with two smaller holes needed and that allow a skilled EP to be very precise in just where along the septal wall they make the puncture for both the ablation catheter and lasso mapping catheter independently from one another.

This can be a huge help in not only avoiding a possible tamponade buy making an inadvertent puncture through the upper roof or upper posterior part of the LA by mistake while trying to manage two catheters through a thicker and wider single sheath.

Also, having dual punctures insures no need to exchange one of more catheters from the RA into the LA and back and forth as can happen when only one puncture and sheath is used. Finally dual punctures allows greater positioning precision for accessing the LAA and LSPV and the hard to get to RSPV and RIPV than does a single puncture and single sheath with two catheters crammed into both.

Just the maneuvering of both catheters via and wider sheath trying to get them both properly positioned you can visually how that might stretch that hole a bit and possible take longer to heal and seal up.

But using dual Transeptal puncture is the gold standard, alone with uninterrupted peri-procedural anti-coagulation protocol and maintaining an ACT (activated clotting time) inside the atria of >350secs which is adjusted and confirmed from just before transeptal puncture is initiated until all hardware is removed from the LA and retracted out of the body altogether to insure a vanishingly low risk of stroke or TIA during or after the procedure, and also a much lower risk of SCI (asymptomatic silent cerebral ischemia) creation.

You may well have had a dual transeptal puncture and still had a period of migraine-like auras but I have not heard of these deja vu dream-like visual hallucinations or whatever they are. Will check around and see if any others describe that particular effect, The good news is that these ablation related migrant auras (not often full migraines headaches themselves) are almost always transitory though can take some time to disappear.

If not and these symptoms continue or get worse be sure and see your EP as a TEE to check and see if any septal defect is still there that might be leaking between left and right atria enough to cause such an issue could be warranted.

Shannon

Rob, can you tell me, was this procedure was done in the UK? And did they use an interrupted anticoagulation protocol where they might have had you on Eliquis, Xeralto or Coumadin for a few weeks at least and then had you stop all OAC drugs for anywhere from 5 days for warfarin to two days for NOAC drugs and then used low molecular weight heparin in the two to three day interim period between stopping the OAC drug and ablation?

If they used such an interrupted peri-procedural anticoagulation and just switched you to IV heparin to raise you ACT to above 300-350 secs right before transeptal puncture, or maybe even right after puncture (I hope they raised ACT prior to puncture) but in checking with an highly experienced ablation EP today about these symptoms, it was noted that those symptoms you reported are usually seen only occasionally and not often, and usually only when interrupted peri-procedural anticoagulation was used instead of the gold standard uniterrupted periprocedural anticoagulation protocol that most every one uses now.

In any event, if you continue to have these symptoms you report or they increase at all, please revisit your EP or cardiologist and strongly request a brain MRI just to be on the safe side. If the symptoms have largely resolved then its likely all just fine.

There is likely nothing to be concerned with as it is, but please do not ignore any lingering ongoing symptoms like the one's you reported.

Shannon



Edited 1 time(s). Last edit at 07/04/2016 09:11AM by Shannon.

I had aural migraines after my first ablation. I thought it might be a stroke and went to the ER. They though it might be the Multaq I had just started. I stopped the Multaq and they stopped after a few days. My second ablation I had two of these type migraines.
I have read similar comments over the years from a small amount of post ablation patients.
I have also read of a higher stroke risk for migraine suffers. There seems to be some connection . What that connection is, is not known.

Don

Hi Shannon,

The procedure was in the UK yes, I was on Warfarin pre and post procedure with a target INR of between 2.5 and (I think) 4.0. I hit an INR of 3.0 leading up to the ablation but had no break leading up to it. The migraines have abated now, well to the normal frequency I suffered beforehand.

Great to hear Ron,

That the migraines have largely abated now. I would not worry at all about any possible complication, even if they continued it is unlikely to have been anything too significant beyond the migraines themselves which are a big enough pain as it is, but the advise to seek out a possible MRI was only as a precaution to make sure all was okay in the event you continued to have these symptoms and visual hallucination-like apparitions.

Very glad to see, like is almost always the case, these unusual type migraine symptoms after an ablation tend to resolve on their own fairly quickly after the ablation.

Cheers!
Shannon

Meant to add that my cardiologist that spoke of the 'dirty blood' (he used that generalisation to simplify the whole idea) booked me in for an MRI which I had around 8 weeks ago, I'm still awaiting the results of that but assume as I've not heard yet that there was nothing untoward seen on the scan.

I must say apart from the odd bit of ectopic activity my heart has been so calm, calmer than I ever remember it. Having had Atrial Tachy before the AF I've pretty much had an 'angry' heart for the last 12 years so it's absolute bliss...

Hello Rob… Glad to read your last entry where you say your heart has been more calm than ever before. Very good news.

However, your comment about ‘angry heart’ prompted me to look up the a paper titled "Fire in the Heart" written by cardiologist, Stephen Sinatra. You can read through Chapter 4 to see if you note any previous, similar symptoms or experiences he mentions in this topic about Inflammation. It's always important to eliminate any potential sources of inflammation in order to keep our hearts peaceful and calm.


“Fire in the Heart”: New Developments in Diagnosis, Prevention
& Treatment of Cardiovascular Disease
Stephen Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.,
& Graham Simpson, M.D.

ABSTRACT
The aim of this paper is to discuss the integration of conventional cardiology and alternative
cardiology. The world of cardiology is moving fast and in multiple directions. In this paper we will
discuss the importance of inflammation and how nutraceuticals can be used in the fight against
cardiovascular disease.[www.a4m.com]

Keywords: inflammation; insulin; detoxification; nutraceuticals; omega fatty acids; CoEnzyme Q10


And a followup web report on 101 Ways to De-stress your Heart...
[inspirenationshow.com]

Jackie

I had an Ablation at the Univ Of Pennsylvania under Dr. David Lin and so far it has been successful he told me it was not a cure but a control. I have had about 5 breakthroughs since the ablation mostly when i was sick. But right after the ablation the next morning i had a migraine aura wavy lines and lights visual disturbances but within about 30 mins it went away. I have had these Auras without the headache however since a teenager so I did not think much of it. I also had some atrial Tac but that went away and everything seemed to work well. The worst thing for me is anxiety over anything that moves around in the chest.