Presentation and treatment of air embolism after cardiac ablation procedure

Hinkle DA, Raizen DM, McGarvey ML, Liu GT.  Cerebral air embolism complicating cardiac ablation procedures.  Neurology 2001; 56:792-794.

Authors present 2 cases of air embolus following cardiac ablation procedure.  In both cases air was suspected of entering the sheath travelling to the left ventricle.  In the first case the patient became confused and apneic and awoke with a gaze preference and hemiplegia, normalized and 2 hours later again became confused and agitated.  Hyperbaric chamber and iv fluids were utilized and the patient improved.

In the second case the patient became agitated and globally aphasic and confused and within 20 minutes awoke with a fluent aphasia.  30 minutes later he became confused again and remained aphasic.  CT and MRI with DWI was normal in both cases.  The first patient had a normal angiogram. 

This presentation of an unusual cause of stroke with an unusual treatment is notable and important to recognize.  Hyperbaric chamber minimizes endothelial thromboinflammatory injury and improves outcome.  A third case was reported separately (Akhtar N, Jafri W, Mozaffar T Neurology 2001l56:136-137).   

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