CTICasesAtrioesophageal Fistula after Atrial Fibrillation Ablation
Imaging findings
A patient presenting with stroke symptoms, intubated, has subtle thickening along the esophagus with blurring of the plane between the esophagus and left atrium and a small dot of air, plus air in the left atrial appendage on CT stroke angiography. History revealed pulmonary vein ablation about three weeks earlier, and brain DWI showed multiple infarcts.
Key takeaways
Atrioesophageal fistula is a rare but devastating complication of atrial fibrillation ablation, in which air (and septic emboli) pass from the esophagus into the left atrium, causing embolic strokes. The findings, esophageal wall thickening, blurring of the esophago-atrial plane, and intracardiac air, are extremely subtle and easily missed without a history of recent ablation, and the diagnosis carries major clinical and medicolegal consequences.
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