Article: Mysterious migraines after heart surgery may finally be explained

[Sly Saint]

After a common heart surgery, some patients experience migraines with visual auras — temporary vision disturbances, such as flashing lights and zigzag lines. The reason for this unusual complication was a mystery, but now, research hints that blood clots in the brain may be the culprit.
"These [clots] have previously not been thought to result in any symptoms or to have any clear adverse consequences," study co-author Dr. Gregory Marcus, a cardiologist at the University of California, San Francisco, told Live Science in an email.

The new study, published July 7 in the journal Heart Rhythm, proposes a new theory about why these mysterious migraines manifest.

To treat arrhythmias, or irregular heartbeats, doctors perform a catheter ablation, which involves inserting a tube into the heart to burn or scar any heart tissue driving the irregularity. About 360,000 people in the U.S. undergo the surgery each year.

Different catheter ablation techniques can be used depending on the location of the faulty heart tissue. One strategy, called "transseptal puncture," creates an opening between two heart chambers, whereas another, known as the "retrograde approach," doesn't require this hole to be made.
But in the months following a catheter ablation, 2.3% of patients with no history of migraines with visual auras report these symptoms for the first time. The auras themselves typically appear just before or during a migraine attack.

These new symptoms are concerning because ischemic stroke, which occurs when blood flow to the brain is blocked, is 2.6 times more likely in people under 45 who experience migraines with visual auras, and it's 3.7 times more likely in women of that same age group who experience them. So these migraines could be harbingers of serious cardiovascular events.

MSN

 

[SNT Gatchaman]

Leveraging A Randomized Trial to Assess Relationships between Transeptal Puncture, Brain Emboli, and Migraine Symptoms
Elias; Tung; Gerstenfeld; Hue; Lin; Cheng; Weiss; Tzou; Hsia; Ehdaie; Cooper; Bunch; Arkles; Nazer; Lee; Hadjis; Nguyen; Chelu; Moss; Hsu; Marcus

BACKGROUND
Catheter ablation procedures with transseptal punctures (usually for atrial fibrillation) are often associated with migraine-related visual auras, but the mechanism remains unknown. Whether this phenomenon is mediated by the creation of an atrial septal defect from transseptal puncture, or alternatively by silent acute brain emboli detected on magnetic resonance imaging (MRI) related to the procedure, remains to be investigated.

OBJECTIVE
To evaluate whether randomization to a transseptal puncture during catheter ablation for ventricular arrhythmias is associated with post-procedural visual auras, and to assess the relationship between occipital and parietal lobes acute brain emboli and migraine-related visual auras.

METHODS
In the TRAVERSE trial, patients undergoing catheter ablation for ventricular arrhythmias were randomized to ventricular access via transseptal puncture versus a retrograde aortic approach. All had brain MRI the day after their procedure and underwent a validated migraine assessment at 1 month.

RESULTS
No difference in post ablation visual auras were observed between transseptal (16% of 63) and retrograde aortic approaches (14% of 57; p=0.78). However, more participants with acute brain emboli in the occipital or parietal lobes experienced migraine-related visual auras (38% vs. 11%; p<0.01). After multivariable adjustment, the presence of acute brain emboli was associated with 12-fold greater odds of visual auras.

CONCLUSIONS
Transseptal puncture was not associated with visual auras, however acute brain emboli involving the visual cortex were associated with such symptoms. These data suggest that transseptal puncture are not causal in migraine-related visual auras and that post-procedure acute brain emboli are apparently not always clinically silent.

Link | Heart Rhythm | Open Access