Atrioesophageal fistula: clinical status and past medical history as the key to proper radiological assessment
Abstract
Atrioesophageal fistula is an extremely rare, but a life-threatening complication of percutaneous ablation. With an increasing prevalence of atrial fibrillation and increasing number of percutaneous ablation procedures following it, awareness of catheter ablation complications and their detection should be raised.
A 69-year-old male, with history of atrial fibrillation admitted with a suspicion of a stroke. The patient was treated with percutaneous ablation 27 days earlier in a different hospital. On admission, in addition to the neurological symptoms, moderately increased inflammatory markers and a low grade fever were found. During the hospitalisation, a prompt inflammatory markers elevation was observed and the patient’s condition had gradually worsened. Sepsis was diagnosed and a broad spectrum antibiotic therapy was administered. On the 6th day of hospitalisation the patient went into cardiac arrest. Cardiopulmonary resuscitation was successful and return of spontaneous circulation occurred. An electrocardiogram showed changes typical for ST elevation myocardial infarction. Emergent coronary angiogram showed no significant stenosis in any of the coronary arteries. In a follow-up brain NECT air emboli were detected. A chest NECT was performed and revealed free gas within the left atrium and in pericardial cavity, which in juxtaposition with the patient’s medical history suggested presence of an atrioesophageal fistula. Despite all taken measures the patient died. An autopsy confirmed atrioesophageal fistula connecting oesophagus with left atrium.
The purpose of this case is to raise awareness of percutaneous ablation complications among both clinicians and radiologists. It emphasizes how crucial precise clinical data and imaging exams are in diagnosing atrioesophageal fistula.
Keywords: atrioesophageal fistulapercutaneous ablationcerebral air embolismatrial fibrillationstroke
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