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Vol 17, No 1 (2022)
Case report
Published online: 2022-02-28

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Atrioesophageal fistula: clinical status and past medical history as the key to proper radiological assessment

Weronika Pleban-Stachera1, Zbigniew Grad1
Folia Cardiologica 2022;17(1):45-49.

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.

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References

  1. Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42(5): 373–498.
  2. Steinbeck G, Sinner MF, Lutz M, et al. Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014. Eur Heart J. 2018; 39(45): 4020–4029.
  3. Arena V, Capelli A. Venous air embolism after cardiopulmonary resuscitation: the first case with histological confirmation. Cardiovasc Pathol. 2010; 19(2): e43–e44.
  4. Leclercq F, Kassnasrallah S, Cesari JB, et al. Transcranial doppler detection of cerebral microemboli during left heart catheterization. Cerebrovasc Dis. 2001; 12(1): 59–65.
  5. Gupta A, Perera T, Ganesan A, et al. Complications of catheter ablation of atrial fibrillation: a systematic review. Circ Arrhythm Electrophysiol. 2013; 6(6): 1082–1088.
  6. Han HC, Ha FJ, Sanders P, et al. Atrioesophageal fistula: clinical presentation, procedural characteristics, diagnostic investigations, and treatment outcomes. Circ Arrhythm Electrophysiol. 2017; 10(11): e005579.
  7. Cappato R, Calkins H, Chen SA, et al. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2009; 53(19): 1798–1803.