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Catheter ablation is a wellknown treatment strategy for patients with symptomatic atrial fibrillation. Despite the benefits in controlling symptoms, the procedure can be associated with complication. Among the most threatening complications, thrombus formation has great importance, since it´s associated with embolic events. In this setting, sheath and catheter associated thrombi have become increasingly identified with the use of intracardiac echocardiography. Despite anticoagulation, these thrombi are found in 10% of cases, with clinical complications in up to 1%. Management of these thrombi includes withdrawal of the sheath and catheter when the thrombi are left to be firmly attached, thrombus aspirations and local thrombolysis. Case Report: We describe a case of early sheath thrombus formation after the first transeptal puncture during atrial fibrillation catheter ablation. This was followed by thrombus detachment and migration from the sheath located in the left atrium. Instead of aborting the procedure, which is the standard approach in such situation, patient had anesthesia reversion, neurologic evaluation and procedure resumption without complications. Conclusion: The routine use of intracardiac echocardiography has contributed to detection of early complications during atrial fibrillation catheter ablation, like thrombus formation. Correct anticoagulation during the procedure is essential, as well as the continuous monitoring of thrombus formation. This is the first case report of temporary general anesthesia reversion after LA thrombus migration to rule out stroke.

Early catheter-associated thrombus formation and migration during pulmonary vein isolation: an approach to rule out stroke and carry on the procedure