Left atrial to esophageal fistula

A case report and literature review

Muhammad Yasir Khan, Waqas Javed Siddiqui, Praneet S. Iyer, Ahmed M Dirweesh, Nigahus Karabulut

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Objective: Unusual clinical course Background: Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablation (RFA) for atrial fibrillation and is associated with high mortality. Clinical features can be nonspecific and include fever, dysphagia, upper gastrointestinal (GI) bleeding, sepsis, and embolic stroke a after recent history of RFA for atrial fibrillation. Case Report: A 57-year-old Caucasian male was brought to the emergency department (ED) by his family because of an altered mental status. He had undergone a radiofrequency ablation for paroxysmal atrial fibrillation three weeks earlier. Several hours after admission to the ED, the patient transiently became unresponsive and had a right sided hemiplegia. A brain MRI revealed multiple cerebral infarcts. On the following day, the patient had an episode of melena, and an esophagogastroduodenoscopy (EGD) was performed which did not reveal any source of bleeding. While the patient was being monitored in the intensive care unit (ICU), he had an episode of hematemesis and went into cardiac arrest from which he was successfully resuscitated and transferred to another facility. He had another EGD, which uncovered a flap of mucosa covering the lower third of his esophagus and a 1 cm fistulous opening was seen with fresh blood oozing out of it. The patient had another cardiac arrest during the endoscopy and died despite all measures. Conclusions: We present this case to stress the importance of early diagnosis of LAEF. LAEF can be fatal if diagnosis is delayed or missed. Early surgical intervention can reduce LAEF morbidity and mortality. Newer diagnostic modalities such as endoscopic ultrasound (EUS) can be helpful in cases where conventional imaging is unclear.

Original languageEnglish (US)
Pages (from-to)814-818
Number of pages5
JournalAmerican Journal of Case Reports
Volume17
DOIs
StatePublished - Nov 2 2016
Externally publishedYes

Fingerprint

Esophageal Fistula
Atrial Fibrillation
Digestive System Endoscopy
Heart Arrest
Hospital Emergency Service
Hemorrhage
Melena
Hematemesis
Hemiplegia
Mortality
Delayed Diagnosis
Deglutition Disorders
Esophagus
Endoscopy
Intensive Care Units
Early Diagnosis
Sepsis
Mucous Membrane
Fever
Stroke

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Endosonography
  • Esophageal fistula
  • Heart atria

Cite this

Left atrial to esophageal fistula : A case report and literature review. / Khan, Muhammad Yasir; Siddiqui, Waqas Javed; Iyer, Praneet S.; Dirweesh, Ahmed M; Karabulut, Nigahus.

In: American Journal of Case Reports, Vol. 17, 02.11.2016, p. 814-818.

Research output: Contribution to journalReview article

Khan, Muhammad Yasir ; Siddiqui, Waqas Javed ; Iyer, Praneet S. ; Dirweesh, Ahmed M ; Karabulut, Nigahus. / Left atrial to esophageal fistula : A case report and literature review. In: American Journal of Case Reports. 2016 ; Vol. 17. pp. 814-818.
@article{27ae0b8e8efd4ba2a13feadbbaa88c3c,
title = "Left atrial to esophageal fistula: A case report and literature review",
abstract = "Objective: Unusual clinical course Background: Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablation (RFA) for atrial fibrillation and is associated with high mortality. Clinical features can be nonspecific and include fever, dysphagia, upper gastrointestinal (GI) bleeding, sepsis, and embolic stroke a after recent history of RFA for atrial fibrillation. Case Report: A 57-year-old Caucasian male was brought to the emergency department (ED) by his family because of an altered mental status. He had undergone a radiofrequency ablation for paroxysmal atrial fibrillation three weeks earlier. Several hours after admission to the ED, the patient transiently became unresponsive and had a right sided hemiplegia. A brain MRI revealed multiple cerebral infarcts. On the following day, the patient had an episode of melena, and an esophagogastroduodenoscopy (EGD) was performed which did not reveal any source of bleeding. While the patient was being monitored in the intensive care unit (ICU), he had an episode of hematemesis and went into cardiac arrest from which he was successfully resuscitated and transferred to another facility. He had another EGD, which uncovered a flap of mucosa covering the lower third of his esophagus and a 1 cm fistulous opening was seen with fresh blood oozing out of it. The patient had another cardiac arrest during the endoscopy and died despite all measures. Conclusions: We present this case to stress the importance of early diagnosis of LAEF. LAEF can be fatal if diagnosis is delayed or missed. Early surgical intervention can reduce LAEF morbidity and mortality. Newer diagnostic modalities such as endoscopic ultrasound (EUS) can be helpful in cases where conventional imaging is unclear.",
keywords = "Atrial fibrillation, Catheter ablation, Endosonography, Esophageal fistula, Heart atria",
author = "Khan, {Muhammad Yasir} and Siddiqui, {Waqas Javed} and Iyer, {Praneet S.} and Dirweesh, {Ahmed M} and Nigahus Karabulut",
year = "2016",
month = "11",
day = "2",
doi = "10.12659/AJCR.899878",
language = "English (US)",
volume = "17",
pages = "814--818",
journal = "American Journal of Case Reports",
issn = "1941-5923",
publisher = "International Scientific Literature, Inc",

}

TY - JOUR

T1 - Left atrial to esophageal fistula

T2 - A case report and literature review

AU - Khan, Muhammad Yasir

AU - Siddiqui, Waqas Javed

AU - Iyer, Praneet S.

AU - Dirweesh, Ahmed M

AU - Karabulut, Nigahus

PY - 2016/11/2

Y1 - 2016/11/2

N2 - Objective: Unusual clinical course Background: Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablation (RFA) for atrial fibrillation and is associated with high mortality. Clinical features can be nonspecific and include fever, dysphagia, upper gastrointestinal (GI) bleeding, sepsis, and embolic stroke a after recent history of RFA for atrial fibrillation. Case Report: A 57-year-old Caucasian male was brought to the emergency department (ED) by his family because of an altered mental status. He had undergone a radiofrequency ablation for paroxysmal atrial fibrillation three weeks earlier. Several hours after admission to the ED, the patient transiently became unresponsive and had a right sided hemiplegia. A brain MRI revealed multiple cerebral infarcts. On the following day, the patient had an episode of melena, and an esophagogastroduodenoscopy (EGD) was performed which did not reveal any source of bleeding. While the patient was being monitored in the intensive care unit (ICU), he had an episode of hematemesis and went into cardiac arrest from which he was successfully resuscitated and transferred to another facility. He had another EGD, which uncovered a flap of mucosa covering the lower third of his esophagus and a 1 cm fistulous opening was seen with fresh blood oozing out of it. The patient had another cardiac arrest during the endoscopy and died despite all measures. Conclusions: We present this case to stress the importance of early diagnosis of LAEF. LAEF can be fatal if diagnosis is delayed or missed. Early surgical intervention can reduce LAEF morbidity and mortality. Newer diagnostic modalities such as endoscopic ultrasound (EUS) can be helpful in cases where conventional imaging is unclear.

AB - Objective: Unusual clinical course Background: Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablation (RFA) for atrial fibrillation and is associated with high mortality. Clinical features can be nonspecific and include fever, dysphagia, upper gastrointestinal (GI) bleeding, sepsis, and embolic stroke a after recent history of RFA for atrial fibrillation. Case Report: A 57-year-old Caucasian male was brought to the emergency department (ED) by his family because of an altered mental status. He had undergone a radiofrequency ablation for paroxysmal atrial fibrillation three weeks earlier. Several hours after admission to the ED, the patient transiently became unresponsive and had a right sided hemiplegia. A brain MRI revealed multiple cerebral infarcts. On the following day, the patient had an episode of melena, and an esophagogastroduodenoscopy (EGD) was performed which did not reveal any source of bleeding. While the patient was being monitored in the intensive care unit (ICU), he had an episode of hematemesis and went into cardiac arrest from which he was successfully resuscitated and transferred to another facility. He had another EGD, which uncovered a flap of mucosa covering the lower third of his esophagus and a 1 cm fistulous opening was seen with fresh blood oozing out of it. The patient had another cardiac arrest during the endoscopy and died despite all measures. Conclusions: We present this case to stress the importance of early diagnosis of LAEF. LAEF can be fatal if diagnosis is delayed or missed. Early surgical intervention can reduce LAEF morbidity and mortality. Newer diagnostic modalities such as endoscopic ultrasound (EUS) can be helpful in cases where conventional imaging is unclear.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Endosonography

KW - Esophageal fistula

KW - Heart atria

UR - http://www.scopus.com/inward/record.url?scp=84994796763&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994796763&partnerID=8YFLogxK

U2 - 10.12659/AJCR.899878

DO - 10.12659/AJCR.899878

M3 - Review article

VL - 17

SP - 814

EP - 818

JO - American Journal of Case Reports

JF - American Journal of Case Reports

SN - 1941-5923

ER -