Abstract Details Title An Unusual Cause of Septic Emboli Topic Cerebrovascular Disease and Interventional Neurology Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM) Poster/Presentation Number 13-009 Objective To report a rare presentation of septic thromboembolic stroke as a delayed complication of cardiac ablation. Background Radiofrequency ablation for atrial fibrillation (RAF) is an increasingly performed procedure, applied especially in patients with refractory atrial fibrillation (AF). A dangerous complication of RAF is Atrial Esophageal (A-E) fistula and prognosis is dependent on a prompt diagnosis. While known to cause pneumomediastinitis, GI bleed or cerebral air embolism, rarely a delayed septic thromboembolic stroke may be the initial presentation. Design/Methods n/a Results 74-year-old male who presented following acute onset of fever, lethargy and left-sided deficits. Neurologic assessment confirmed altered mental status and left hemiplegia. Blood cultures revealed gram-positive cocci in chains. Lumbar puncture revealed pleocytosis, increased protein and increased glucose. Patient was started empirically on broad spectrum antibiotics due to concerns for endocarditis. Relevant history included a RAF 30 days prior to presentation. In the post-operative period, patient had no complaints and was in his usual state of health. Magnetic resonance imaging (MRI) showed bihemispheric non-hemorrhagic infarcts with pachymeningeal enhancement. Transthoracic echocardiogram showed a mass on the atrial wall. CT chest with contrast demonstrated air in the wall of the left atrium. Patient underwent emergency surgery. Operative report confirmed A-E fistula and described destruction of the endocardium with a large polymicrobial vegetation on the atrial wall. Neurological deficits persisted after surgical repair. Conclusions In patients with meningitis, stroke, seizures, or impaired consciousness and fever, it should be determined whether they have had a previous RAF. In cases with a history of recent RAF, A-E fistula should be strongly considered since outcome can be catastrophic. Thus, awareness of A-E fistula by the neurologist may play a crucial role in the survival of patients that develop this complication after an increasingly performed procedure. Authors/Disclosures Mariel Davila Martinez, MD PRESENTER Dr. Davila Martinez has nothing to disclose.