Left atrial-oesophageal fistula is a rare but potentially fatal complication of radiofrequency ablation for atrial fibrillation that can present with a triad of infections, neurological sequelae, and air in the left atrium.
Answers are grounded in this paper and cite their sources.
Prompts vigilance for atrio-oesophageal fistula in post-ablation sepsis with neurological signs; extends sparse case data but leaves prevention strategies open.
A 56-year-old man underwent radiofrequency ablation for atrial fibrillation. Four weeks later he presented with sepsis and neurological symptoms. Urine analysis demonstrated the presence of blood and protein. A CT scan showed pockets of air in the left atrium. An MRI brain scan revealed multiple cerebral abscesses. The patient developed a third heart sound and splinter haemorrhages. He was subsequently referred to cardiology for transoesophageal echocardiography after starting a course of intravenous meropenem. The cardiology team noted that this individual presented with a triad of infections, neurological sequelae and air in the left atrium after an ablation procedure and diagnosed atrio-oesophageal fistula. A decision to operate was made 9 days after admission. At surgery an area of caseous ulceration was found on the posterior wall of the left atrium overlying the oesophagus. PCR analysis revealed Mycoplasma salivarium, part of the oral flora.
No takes yet. Share an insight, caveat, or question.
Garala et al. (2013) studied this question.
Synapse has enriched 10 related papers. Consider them for comparative context: