Self-sealing Atrio-oesophageal Fistula As a Complication of Pulmonary Vein Isolation: a Case Report

Overview

Journal Eur Heart J Case Rep

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2024 Jun 25

PMID 38915738

Authors

Nicolas Herrera-Parra

Enrique Carlos Garcia-Pretelt

Camilo Hernan Bonilla-Cortes

Eduardo Ortiz

Affiliations

Soon will be listed here.

Abstract

Background: Atrio-oesophageal fistulas (AEFs) are an uncommon complication of pulmonary vein ablation, and its diagnosis is challenging. Multidisciplinary interventions and diagnostic imaging are usually required and may play a role in the initial assessment.

Case Summary: A 69-year-old female with atrial fibrillation who had undergone recent pulmonary vein ablation consulted with unspecific symptoms and sudden hemiparesis. Brain imaging showed pneumocephalus and acute infarcts. Chest computed tomography (CT) was highly suspicious for AEF. Surgical exploration revealed a swollen mediastinum attached to the right inferior pulmonary vein.

Discussion: Non-specific symptoms after pulmonary vein ablation should prompt the suspicion of complications. In the presence of fever or neurological deficit, AEF must be suspected and assessed with a contrast-enhanced chest CT, which has become the gold standard. In brain imaging, pneumocephalus and multiple punctate acute infarcts might also indicate the presence of this complication.

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