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CASE REPORT
Left atrial-oesophageal fistula: a very rare, potentially fatal complication of radiofrequency ablation for atrial fibrillation
  1. Kanai Garala1,
  2. Ashan Gunarathne2,
  3. Martin Jarvis3,
  4. Peter Stafford3
  1. 1University Hospitals Leicester, Glenfield Hospital, Leicester, UK
  2. 2Department of Cardiology, Glenfield Hospital, Leicester, UK
  3. 3Glenfield Hospital, Leicester, UK
  1. Correspondence to Dr Kanai Garala, kanaigarala{at}gmail.com

Summary

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.

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