Abstract Details

Title A Case of Atrioesophageal Fistula as a Rare Complication of Atrial Fibrillation Ablation Leading to Multifocal Embolic Ischemic Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-002

Objective To describe a case of multifocal embolic ischemic strokes due to atrioesophageal fistula (AEF) as a complication of atrial fibrillation (AF) ablation.

Background AEF is a rare and serious complication of AF ablation with an incidence of < 0.1%. Clinical presentation occurs at a median time of 21 days post procedure and most commonly includes fever, neurological, and gastrointestinal symptoms. CT chest can be used for diagnosis. Treatment includes esophageal stenting or open surgery to repair the esophagus and/or pericardium/left atrium. Overall mortality of AEF is 55%, but nearly 100% without treatment.

Design/Methods Case report and literature review.

Results A 70-year-old male with mitral valve prolapse and AF presented to the hospital for fevers three weeks following elective pulmonary vein isolation radiofrequency ablation. Post procedure, he noticed pain between his shoulder blades when lying down or taking a deep breath and was given pantoprazole for presumed gastroesophageal reflux. He was later admitted to the hospital for fevers and rigors with blood cultures growing streptococcus salivarius and mitis-oralis. He later developed somnolence, dysarthria, and right sided weakness. Brain MRI showed numerous multifocal ischemic strokes involving all vascular territories consistent with central embolic etiology. Transthoracic echocardiogram did not show any valvular vegetations. Given presence of polymicrobial oral flora bacteremia in the setting of recent AF ablation with extensive central embolic strokes, there was concern for AEF and he underwent CT chest that showed ruptured fistula between the left atrium and esophagus with contained air. Treatment was offered with esophageal stent versus open surgical repair, however, the patient’s family elected to transition to hospice and he died one week later.

Conclusions

AEF is an underrecognized and often misdiagnosed rare complication of AF ablation. Rapid recognition of AEF is indicated for patients presenting with fevers and neurological symptoms few weeks after ablation as untreated AEF is essentially fatal.

Authors/Disclosures
Merry Huang, MD (Cleveland Clinic) PRESENTER	Dr. Huang has nothing to disclose.
Eric Dunn, DO (Cleveland Clinic Foundation)	Dr. Dunn has nothing to disclose.
	No disclosure on file

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