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After a pulsed field ablation atrial fibrillation procedure using a volt catheter, advisor hd grid x catheter, agilis 13f sheath, ensite x, and a non-abbott (boston scientific versacross) wire, the patient experienced a stroke.The patient was found unresponsive four days following the procedure.Patient was noted to be cyanotic, with cold extremities and right sided hemiparesis.The patient was outside of the tpa thrombectomy window and was transferred to a neurological icu.A head ct showed large left mca territory infarct, complete loss of grey/white definition, and a midline shift.Additionally, the patient was noted to have such pronounced brain swelling that most treatments were not pursued.Prior to the procedure, a tee was performed to rule out thrombus as the patient had missed 1-2 does of their pradaxa prescription.It was noted when the ice catheter was advanced that a baseline effusion was present.The transseptal puncture was then performed using a non-abbott (boston scientific versacross) wire and sheath.Following transseptal puncture, the non-abbott wire and sheath were replaced with an agilis 13f sheath.It was noted that the effusion was still at baseline.The advisor hd grid x catheter was then advanced, and an initial voltage map of the left atrium was performed.The advisor hd grid x catheter was then exchanged for a volt catheter and the procedure was performed.The ablation was done with the volt catheter inflated at 8cc and there were no issues noted throughout the ablation.The volt catheter was then exchanged for the advisor hd grid x catheter for post-mapping to confirm isolation.All catheters were removed and the effusion was noted to be stable at the end of the procedure.There were no performance issues noted with any abbott devices.The patient was discharged later the same day and resumed their pradaxa.The patient passed away six days post-procedure.Additional information was received which notes the patient had an elevated intrinsic risk for stroke which may have been exacerbated by missed doses of the patient's anticoagulation medication prior to the procedure.The patient had a chadsvasc score of 3.
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