BACKGROUND: Atrial-esophageal fistula (AEF) is a rare and early complication of radiofrequency ablation for medically refractory atrial fibrillation, but has devastating consequences when the diagnosis is delayed or difficult to make. METHODS: Single case in a neurosciences critical care center. RESULTS: A 69-year-old man with significant cardiac and neurologic medical history who underwent atrial fibrillation ablation 50 days prior to admission to the neurocritical care unit presented with acute left-sided weakness and gram-positive bacterial sepsis. This is an exceptional case discussing the need for early detection of AEF presenting with sepsis, neurologic deficit along with complicated decision-making in the neurocritical care setting. His hospital course was complicated by acute stroke, left ventricular (LV) aneurysm with thrombus, gastrointestinal (GI) bleed discovered to be from left atrial esophageal fistula, and subsequent cerebral air emboli leading to death. CONCLUSIONS: This is the most delayed presentation of AEF following atrial fibrillation ablation reported in the literature to date. We emphasize the need for awareness of this complication even after such an unexpected time-frame postprocedure as well as the unintended complications of cerebral air emboli following upper endoscopy.
BACKGROUND:Atrial-esophageal fistula (AEF) is a rare and early complication of radiofrequency ablation for medically refractory atrial fibrillation, but has devastating consequences when the diagnosis is delayed or difficult to make. METHODS: Single case in a neurosciences critical care center. RESULTS: A 69-year-old man with significant cardiac and neurologic medical history who underwent atrial fibrillation ablation 50 days prior to admission to the neurocritical care unit presented with acute left-sided weakness and gram-positive bacterial sepsis. This is an exceptional case discussing the need for early detection of AEF presenting with sepsis, neurologic deficit along with complicated decision-making in the neurocritical care setting. His hospital course was complicated by acute stroke, left ventricular (LV) aneurysm with thrombus, gastrointestinal (GI) bleed discovered to be from left atrial esophageal fistula, and subsequent cerebral air emboli leading to death. CONCLUSIONS: This is the most delayed presentation of AEF following atrial fibrillation ablation reported in the literature to date. We emphasize the need for awareness of this complication even after such an unexpected time-frame postprocedure as well as the unintended complications of cerebral air emboli following upper endoscopy.
Entities:
Keywords:
AEF; atrial esophageal fistula; atrial fibrillation; cerebral air emboli; left ventricular aneurysm
Authors: Damian Sánchez-Quintana; José Angel Cabrera; Vicente Climent; Jerónimo Farré; Maria Cristina de Mendonça; Siew Yen Ho Journal: Circulation Date: 2005-08-29 Impact factor: 29.690
Authors: Hakan Oral; Carlo Pappone; Aman Chugh; Eric Good; Frank Bogun; Frank Pelosi; Eric R Bates; Michael H Lehmann; Gabriele Vicedomini; Giuseppe Augello; Eustachio Agricola; Simone Sala; Vincenzo Santinelli; Fred Morady Journal: N Engl J Med Date: 2006-03-02 Impact factor: 91.245
Authors: T L Williams; D R Parikh; J R Hopkin; T G Lukovits; A T Kono; A C Mamourian; B T Harris Journal: Neurology Date: 2009-03-24 Impact factor: 9.910
Authors: Geoffrey Lee; Paul B Sparks; Joseph B Morton; Peter M Kistler; Jitendra K Vohra; Caroline Medi; Raphael Rosso; Andrew Teh; Karen Halloran; Jonathan M Kalman Journal: J Cardiovasc Electrophysiol Date: 2010-08-19
Authors: Jennifer E Cummings; Robert A Schweikert; Walid I Saliba; J David Burkhardt; Fethi Kilikaslan; Eduardo Saad; Andrea Natale Journal: Ann Intern Med Date: 2006-04-18 Impact factor: 25.391
Authors: Nicolas Doll; Michael A Borger; Alexander Fabricius; Susann Stephan; Jan Gummert; Friedrich W Mohr; Johann Hauss; Hans Kottkamp; Gerd Hindricks Journal: J Thorac Cardiovasc Surg Date: 2003-04 Impact factor: 5.209