Acute fever and seizure in a patient with recent atrial fibrillation ablation

Alice Gallo de Moraes, Pratik A. Patel, Elizabeth Mahal, Christopher L. Kramer, Juan C. Diaz Soto, Teng Moua

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Patients undergoing radiofrequency ablation for treatment of atrial fibrillation may present critically ill with complications of atrial esophageal fistula, commonly manifesting as neurologic deficits and septicemia difficult to distinguish from other acute etiologies without a high index of suspicion. The temporal variability in fistula formation and symptom presentation, along with their nonspecific features, makes diagnosis often a late finding with historically high morbidity and mortality. We present a patient admitted to a medical intensive care unit with status epilepticus and recurrent positive blood cultures for organisms commonly associated with the gastrointestinal (GI) tract. Chest computed tomography (CT) without contrast, transthoracic echocardiography, and initial neurologic imaging were unhelpful. Adiagnosis was ultimately made by upper endoscopy of the esophagus after hematemesis with suspicion for GI bleed, at which point surgical intervention was attempted but without success. This case reviews the clinical features of atrial esophageal fistula formation and its initial diagnosis and management.

Original languageEnglish (US)
Pages (from-to)314-316
Number of pages3
JournalHeart and Lung: Journal of Acute and Critical Care
Volume44
Issue number4
DOIs
StatePublished - Jul 1 2015

Keywords

  • Atrial fibrillation ablation
  • Atrial-esophageal fistula
  • Fever
  • Seizure
  • Sepsis

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