Atrio-esohageal fistula following left atrial ablation

Case contributed by Stefan Tigges

Presentation

Syncope and left hemiparesis, left atrial ablation procedure for atrial fibrillation 1 month prior.

Patient Data

Age: 60 years.
Gender: Male

Feeding tube appropriately positioned, pulmonary hypoinflation with bibasilar atelectasis, calcified granulomas right lower lobe, otherwise normal.

 Patchy hypodensities within the right greater than left posterior parietal lobes, most compatible with evolving infarctions.  Scattered foci of air in the bilateral cerebral sulci along the bilateral parietal convexities, likely intravascular air emboli.

 Multiple acute infarctions, largest areas of involvement involving the right cerebellum and right hippocampus. No hemorrhagic transformation, mass effect or midline shift.

Air bubbles right atrium and right ventricle, possibly from prior venipuncture. Small amount of air posterior to the left atrium, adjacent to the feeding tube in the esophagus, suspicious for atrioesophageal fistula secondary to left atrial ablation. Possible air bubbles in the left atrium. Bibasilar atelectasis.

Evolving multiple bilateral infarcts, most prominent in the right cerebellum and right cerebral hemisphere. No hemorrhagic conversion.

Case Discussion

Atrioesophageal fistula formation is a potential complication of ablation for atrial fibrillation because the esophagus is directly posterior to the left atrium. This complication has a high mortality rate. Findings are often subtle and a high index of suspicion is required. In this case, the fistula was successfully repaired and the patient was discharged from the hospital after one month. 

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