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Visual auras, like those that occur in migraines, may be signs of small injuries to the brain’s visual cortex, according to a clinical trial at UC San Francisco that tracked the appearance of these lesions after procedures to treat abnormal heart rhythms.
The study, which appeared July 7 in Heart Rhythm, found that patients with lesions in the occipital and parietal lobe were 12 times more likely than those who did not have them to experience migraine-related visual auras.[1]
“These data suggest that visual auras that commonly occur with migraines may actually signal brain injury or little strokes. This finding could change the whole paradigm of treatment, perhaps focusing more on prevention of blood clots.”
Gregory M. Marcus, MD, MAS, Cardiologist, Director of Clinical Research UCSF
Patients were randomly assigned to two types of catheter ablation for ventricular arrhythmias.
One approach was achieved by a transseptal puncture (creating a new, temporary hole between the left and right atria) and the other by a retrograde approach through the aortic valve, which did not require a transseptal puncture.
Past research had suggested that these small holes between the atria (patent formallow for shunting of an unknown chemical that goes directly from the venous circulation to the left-sided circulation (and therefore to the brain) that usually would be metabolized by the lungs.
Another possible explanation is that the hole allows passage of small blood clots that form in veins of the legs and then block blood flow to small areas of the brain.
Similarly, migraines have been associated with a small hole in the same location, also known as patent foramen ovale.
The day after the procedure, the researchers obtained brain MRIs for all patients in both groups.
Both procedures are known to result in small brain lesions which could be seen on the MRIs the next day.
Neither procedure was more likely to produce lesions. But the patients who did have lesions immediately after the procedure were far more likely to have auras a month later.
By then, however, in many cases the lesions were no longer visible on brain scans.
“We know that these brain lesions are seen after very common procedures including after coronary angiograms, after transcutaneous replacement of aortic valves (TAVRs), after ablations for atrial fibrillation and ventricular arrhythmias and are often referred to ‘ACEs’ — asymptomatic cerebral emboli."
Adi Elias, MD, Cardiac Electrophysiology Fellow UCSF
“Our data show they are not asymptomatic or clinically silent,” he said. “It may be the case that we haven’t known what to look for and that we assessed for symptoms immediately without enough time for the subsequent visual auras that would occur.”
References
1.https://www.heartrhythmjournal.com/article/S1547-5271(25)02614-1/fulltext
2.https://www.ucsfhealth.org/providers/gregory-m-marcus
3.https://ucsfhealthcardiology.ucsf.edu/news/electrophysiology-fellows-class-2025-26
[Newswise/SS]
