Atrioesophageal Fistula with Meningitis: A Rare Complication of Atrial Fibrillation Ablation, Case Report and Literature Review

Division

South Atlantic

Hospital

Grand Strand Medical Center

Document Type

Manuscript

Publication Date

9-1-2020

Keywords

Atrioesophageal fistula, Catheter ablation, Atrial fibrillation, Meningitis, Septic emboli

Disciplines

Cardiovascular Diseases | Diagnosis | Internal Medicine | Nervous System Diseases

Abstract

Atrioesophageal fistula is a rare, devastating complication of atrial fibrillation ablation, reportedly occurring in 0.015-0.04% of catheter ablations. A 66-year-old African American male with a past medical history of chronic atrial fibrillation status post recent radiofrequency ablation and on chronic anticoagulation with rivaroxaban presented with left upper extremity numbness, tingling, and transient weakness. He was admitted for a cerebrovascular accident workup; a 12-lead electrocardiogram revealed atrial fibrillation and magnetic resonance imaging of the brain was consistent with multifocal embolic infarcts. Hospital course was further complicated by persistent high-grade fevers, gram-positive bacteremia, and worsening mental status requiring mechanical ventilation. Lumbar puncture was consistent with bacterial meningitis. Transthoracic echocardiogram was negative for vegetations. Computed tomography angiography of the chest with intravenous contrast revealed an outpouching off the posterior wall of the left atrium at the level of the inferior pulmonary vein, consistent with an atrioesophageal fistula. We present this case to highlight the clinical features of a rare but potentially fatal complication from a commonly performed procedure requiring prompt recognition and life-saving intervention.

Publisher or Conference

Annals of Medicine & Surgery

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