Cerebral air embolization in the Electrophysiology Laboratory during Transseptal Catheterization: Curative treatment of acute left hemiparesis with prompt hyperbaric oxygen therapy

Abstract

We present a case of a 44 year-old man with medically refractory symptomatic paroxysmal atrial fibrillation in whom the initial attempt at left atrial catheter ablation was complicated by coronary and cerebral arterial air embolization during transseptal catheter exchange. The manifestations, management, and long term outcomes are detailed. Following the case report is a review of published reports and contemporary management strategies for treatment of acute air embolization. Dramatic clinical consequences can be aborted by prompt intervention including volume loading, oxygenation, lidocaine, and hyperbaric oxygen therapy.

Complications of Atrial Fibrillation Ablation in a High‐Volume Center in 1,000 Procedures: Still Cause for Concern?

“…We did not observe other previously reported rare complications such as air embolism, coronary artery damage, or radiation injury 17–19 . We also did not observe cases of acute pyloric spasm and gastric hypomotility following ablation as reported by Shah et al 20 .…”

Venice Chart International Consensus Document on Atrial Fibrillation Ablation: 2011 Update

“…If the signs of an embolus persist, coronary angiography and, if necessary, aspiration of air from within the coronary artery should be considered. Treatment of large cerebral air emboli with prompt hyperbaric oxygen may have clinical value 232 …”

Coma and seizures due to gas emboli following extubation

“…Hyperbaric oxygen reduces bubble size through a combination of pressure (Boyle's Law) and increasing the nitrogen gradient within air emboli, and may be successful when initiated within 6 hours. 10 In this case, hyperbaric oxygen was contraindicated by barotrauma, 11 but the emboli would have had a high fraction of oxygen as a result of pre-oxygenation and Cook catheter insufflation. This would have increased oxygen diffusion and reduction in bubble size, probably contributing to a more favourable outcome.…”