Use of tissue plasminogen activator in a stroke after radiofrequency ablation of a left-sided accessory pathway

We describe the case of a 12-year-old girl who had a thromboembolic stroke after radiofrequency ablation of a left posterior accessory pathway involvi ng a transseptal procedure. Symptoms of a stroke occurred 7 hours 15 minute s after completion of the procedure. Tissue plasminogen activator (tPA) was given 2 hours 30 minutes after the onset of symptoms, with complete resolu tion of her neurologic symptoms, No adverse effects from the tPA were seen. Because of the late onset of symptoms in this case, overnight in-hospital observation is warranted for patients who undergo radiofrequency ablation o f a left-sided accessory pathway or an accessory pathway in a patient with the ability to shunt right to left, In this case, tPA was an effective and safe drug to use following a cerebral thromboembolic event occurring after a cardiac catheterization procedure.