A 72-year-old woman presented to the hospital for cough, fever and shortness of breath. She had recently developed atrial fibrillation and had a successful cryo-balloon pulmonary vein isolation three weeks before admission. She had a history of rate-related cardiomyopathy secondary to atrial flutter. She had a chest radiograph demonstrating a left lower zone opacity and a mildly elevated white cell count of 10 x 10^6 /L and a C-reactive protein of 170. She improved over the next 48 hours with intravenous antibiotics. On the day of discharge she had an emergency call out for a reduced level of consciousness. She was found to be obtunded with an extensor plantar response to pain. Computed tomography (CT) head imaging demonstrated multiple small hypodensities consistent with air embolism. She was intubated and admitted to the critical care unit. CT imaging of her chest revealed an atrial-esophageal fistula likely secondary to her recent ablation procedure. She passed with one day later secondary to further massive air embolism.