Transient ischaemic attack due to incidental late electrical isolation of the
left atrial appendage: a case report
#MMPMID41384089
Kuraoka S
; Nozoe M
; Uchikawa T
; Nagatomo D
; Kubota T
Eur Heart J Case Rep
2025[Dec]; 9
(12
): ytaf622
PMID41384089
show ga
BACKGROUND: Electrical isolation of the left atrial appendage (LAA) during
catheter ablation may increase the risk of thrombo-embolism, even in patients
with low stroke risk scores and sinus rhythm. Late incidental isolation of the
LAA has been rarely reported as a cause of transient ischaemic attack (TIA). CASE
SUMMARY: A 73-year-old woman with a CHADS2 score of 0 underwent three catheter
ablation sessions for long-standing persistent atrial fibrillation. Incomplete
anterior mitral line ablation during the first and second sessions led to
recurrent mitral flutter. At the third session, mitral flutter was successfully
terminated by linear ablation at the left mitral isthmus, and electrical
conduction to the LAA remained via the anterior LA wall. Anticoagulation was
discontinued post-ablation. Five years later, she developed a TIA despite
maintaining sinus rhythm. Four years after the TIA, she presented with atrial
tachycardia. Voltage mapping during a fourth ablation revealed extensive
anterolateral LA scarring and the absence of LAA electrograms, consistent with
late incidental LAA isolation. Given her thrombo-embolic risk, percutaneous LAA
closure with a WATCHMAN FLX device was successfully performed. DISCUSSION: This
case suggests that linear ablations forming a substrate around the LAA may lead
to its progressive electrical isolation over time, increasing thrombo-embolic
risk despite sustained sinus rhythm and low stroke risk scores.
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