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One day following a pulsed field ablation (pfa) procedure, the patient reported abnormal vision.Subsequent magnetic resonance imaging (mri) confirmed a cerebrovascular accident (cva), with evidence of infarction in the subcortical white matter.The patient¿s hospitalization was extended; however, no therapeutic intervention was undertaken for the cva.Prior to the ablation procedure, intra-arterial thrombus was excluded via transesophageal echocardiography (tee).The reporting physician indicated that the etiology of the cva may be attributed either to the index procedure or to the patient¿s history of atrial fibrillation persisting for five days without anticoagulation therapy.Additionally, an arteriovenous (av) fistula was identified by duplex sonography.Management included repeated applications of manual compression and pressure bandaging over the subsequent days.The fistula was not associated with hemodynamic compromise at any point.A hematoma and localized pain were also observed.The physician assessed the av fistula as likely related to vascular access (puncture-related).No performance issues were identified with any abbott devices, and no unexpected procedural complications were reported.The patient had no prior history of cva.Anticoagulation during the procedure included heparin administration, with an average activated clotting time (act) of approximately 376 seconds.No anticoagulation bridging was performed.Relevant comorbidities included preexisting hypertension and obesity.
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