Atrio-Esophageal Fistula: A Rare Entity Complicating a Common Procedure.
Ivanna A SanojaPublished in: Case reports in critical care (2023)
A 66-year-old female with a history of radiofrequency ablation for atrial fibrillation presented with hematemesis and fever. A CT chest revealed an atrio-esophageal fistula (AEF) and a CT head showed bilateral septic emboli. Blood cultures were positive for Streptococcus sanguinis . She underwent primary repair of the atrial defect on cardiopulmonary bypass where a large atrial vegetation was retrieved, followed by a right thoracotomy with the closure of the esophageal defect the next day. She was discharged to a rehabilitation facility after 18 days of hospital stay with a 6 weeks antibiotics plan. The incidence of AEF following ablation procedures has been estimated at 0.01 to 0.04%, and the pathogenesis is linked to direct tissue and vagus nerve injury. The most common clinical findings are fever and neurologic deficits. CT chest is the best diagnostic modality. CT head might demonstrate embolic phenomena and TTE can show vegetation. Early surgical intervention, even in an unstable patient, is paramount for survival.
Keyphrases
- image quality
- atrial fibrillation
- dual energy
- radiofrequency ablation
- computed tomography
- contrast enhanced
- catheter ablation
- climate change
- left atrial
- positron emission tomography
- healthcare
- magnetic resonance imaging
- traumatic brain injury
- case report
- emergency department
- risk factors
- percutaneous coronary intervention
- single cell
- magnetic resonance
- staphylococcus aureus
- coronary artery disease
- optic nerve
- direct oral anticoagulants
- oral anticoagulants
- adverse drug
- aortic valve replacement
- gestational age
- minimally invasive
- preterm birth
- ejection fraction
- venous thromboembolism
- drug induced
- electronic health record