What causes blurred vision after cardiac radiofrequency ablation (RFA)?

From the Guidelines

If you're experiencing blurred vision after a heart ablation procedure, you should contact your healthcare provider immediately as this could be a concerning symptom. Blurred vision is not a typical or expected side effect of cardiac ablation procedures. This symptom could potentially indicate a complication such as a stroke or transient ischemic attack (TIA), which can occur rarely after ablation due to blood clots forming during the procedure, as noted in studies such as 1. Other possibilities include a reaction to medications given during the procedure, changes in blood pressure affecting vision, or simply fatigue and stress from the procedure itself. Your doctor might recommend an urgent neurological evaluation, possibly including imaging studies like an MRI or CT scan of the brain, as suggested by the guidelines outlined in 1 and 1. While waiting to see your doctor, avoid driving or operating machinery, and have someone stay with you to monitor your condition. The timing of the symptom is important - if it occurred immediately after the procedure, it's more concerning than if it developed days later, as discussed in 1. Some key points to consider include:

• The incidence of complications from catheter ablation is low, but serious complications can occur, including valvular disruption, coronary occlusion, cerebrovascular accident, and death, as reported in 1.
• The most common complication in AV node modification has been the development of heart block through the inadvertent ablation of both the fast and slow AV nodal pathways, as noted in 1.
• Despite these complications, studies have clearly shown that symptomatic patients are afforded important improvements in the quality of life with catheter ablation, as discussed in 1 and 1. Remember that prompt medical attention for visual changes after a cardiac procedure could prevent more serious complications.

From the Research

Blurred Vision after Heart Ablation

• Blurred vision after heart ablation can be a symptom of various conditions, including migraine with visual aura 2 or retinal and optic nerve ischemia 3.
• A study published in the Journal of Atrial Fibrillation reported a case of a 58-year-old woman who developed a headache and visual disturbances after a cryoballoon ablation procedure for atrial fibrillation 2.
• The patient's symptoms resolved completely after several days, and she was given a diagnosis of new onset migraine with visual aura 2.
• Another study published in Continuum (Minneapolis, Minn.) discussed the importance of ruling out giant cell arteritis in patients with acute retinal or optic nerve ischemia 3.
• The study also emphasized the need to evaluate and manage patients with central retinal artery occlusion or transient visual loss emergently, similar to patients with cerebral ischemia 3.

Possible Causes and Mechanisms

• The blinding period following ablation therapy for atrial fibrillation may be related to proarrhythmic and antiarrhythmic pathophysiological mechanisms 4.
• A review published in JACC: Clinical Electrophysiology proposed that stretch-reducing ablation scar is a permanent antiarrhythmic mechanism that develops during the blinding period and is the reason for delayed cure 4.
• Ischemic arterial disease affecting the retina and occipital lobe can also cause visual disturbances, including blurred vision 5.
• A study published in Survey of Ophthalmology reviewed the evidence for managing patients presenting with visual symptoms of vascular events, including stroke and transient ischemic attacks 5.

Diagnosis and Management

• Diagnosis and management of transient ischemic attack and acute ischemic stroke are crucial in patients presenting with visual symptoms 6.
• A review published in JAMA discussed the importance of dual antiplatelet therapy, carotid revascularization, and anticoagulation in patients with symptomatic carotid stenosis or atrial fibrillation 6.
• The review also emphasized the need for prompt treatment, including intravenous alteplase and mechanical thrombectomy, in patients with disabling acute ischemic stroke 6.