This patient presented to the emergency department one month post-radiofrequency ablation for atrial fibrillation with a positive COVID-19 test and hematemesis. Chest x-ray was positive for bilateral infiltrates. GI was consulted for “COVID-19 GI Bleed” and an esophagogastroduodenoscopy (EGD) was performed to evaluate the hematemesis. The patient passed away from widespread air emboli in the brain. CT detected an atrio-esophageal fistula as a complication of the radiofrequency ablation. Widespread systemic air emboli were likely introduced through the fistula during EGD.

Case contributed by: Kamil Abu-Shaban, Xiaochen Liu MD & Bruce Siders DO.