CTICasesAtrial-Esophageal Fistula
Imaging findings
CT imaging demonstrates a small focus of gas along the esophagus and thickening of both the esophagus and the posterior wall of the left atrium, status post ablation. Early imaging also showed subtle gas layering in the left atrial appendage, which was no longer visible on subsequent scans.
Key takeaways
Atrial-esophageal fistula is a rare but highly lethal complication of radiofrequency catheter ablation for atrial fibrillation. Early detection is critical, and clinicians should maintain a high index of suspicion in post-ablation patients presenting with neurological symptoms (due to air embolism causing strokes) or cardiac ischemia.
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