SHM Converge Scientific Abstract ePoster Gallery-Atrial Esophageal Fistula a Rare Complication of Atrial Fibrillation Ablation

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This case report describes a rare but life-threatening complication of atrial fibrillation ablation: atrial-esophageal fistula (AEF). A 59-year-old man with paroxysmal atrial fibrillation developed fever, chills, nausea, bacteremia, left-sided weakness, and hematemesis about two weeks after a repeat radiofrequency ablation. Initial evaluation suggested possible mitral valve vegetation and septic emboli, but brain MRI showed tiny embolic infarcts. After transfer for further care, cardiac CT demonstrated esophageal wall thickening, air outside the esophagus, and a fistulous tract adjacent to the left atrium, strongly indicating AEF.<br /><br />The patient underwent urgent surgical repair with a pericardial patch and esophageal stent placement. Cultures were negative after transfer, and he was treated with ertapenem and fluconazole. He was discharged on amiodarone, esomeprazole, atorvastatin, and apixaban, with strict NPO status and PEG tube feeding.<br /><br />The discussion emphasizes that esophageal injury occurs in a small percentage of atrial ablation procedures and may progress to AEF due to thermal damage and ulceration. Symptoms are often nonspecific and typically appear 1 to 6 weeks after ablation, including fever, chest discomfort, vomiting, hematemesis, neurologic deficits, and bacteremia. Because insufflation can worsen the fistula and cause air embolism, transesophageal echocardiography and upper endoscopy should be avoided when AEF is suspected. Instead, CT chest with IV contrast is recommended.<br /><br />The key takeaway is that clinicians must maintain a high index of suspicion for AEF in patients with constitutional or neurologic symptoms after atrial fibrillation ablation, as early imaging diagnosis and prompt surgical management are critical to survival.

Asset Subtitle

Michael D. McCafferty

Meta Tag

Author List Michael D. McCafferty, Thura T. Harfi

Category Clinical Vignettes

Concept Atrial-Esophageal Fistula

Concept Surgical Repair

Concept Chest Computed Tomography

Concept Esophageal Injury

Concept Fistula Formation

Distinguished Non-Finalist

Presenter Organization The Ohio State University Wexner Medical Center

Presenting Author Michael D. McCafferty

Track Adult

Keywords

atrial-esophageal fistula

atrial fibrillation ablation

radiofrequency ablation

esophageal injury

cardiac CT

bacteremia

hematemesis

embolic infarcts

surgical repair

neurologic deficits

Atrial-Esophageal Fistula

Surgical Repair

Chest Computed Tomography

Esophageal Injury

Fistula Formation