Atrioesophageal Fistula after Ablation for Atrial Fibrillation

The Journal of Emergency Medicine
Trisha Mackle, Kevin Pistawka

Abstract

Atrioesophageal fistula (AEF) is a rare and highly fatal complication of ablation procedures for atrial fibrillation. We report a diagnostically challenging case of AEF that highlights the unfortunate outcome that can be expected when this condition is not promptly diagnosed and managed accordingly. The varied clinical presentations are reviewed and recommended diagnostic and management approaches are presented. A 79-year-old female who was 5 weeks post-ablation presented to a community emergency department with chest pain and a transient episode of left-arm weakness. Troponin was mildly elevated, but other investigations, including thoracic and head computed tomography (CT) were normal. During the course of the next few days in hospital, the diagnosis of AEF became apparent, as the patient developed a fever and recurrent episodes of neurologic deficits along with blood cultures that yielded upper gastrointestinal flora. The patient was urgently transferred to a tertiary center where repeat thoracic CT confirmed the diagnosis, but she succumbed to an intracranial bleed before definitive surgical management could be performed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case is presented to increase awareness among...Continue Reading

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