CTICasesAtrioesophageal Fistula Post-Left Atrial Ablation
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Imaging findings
Chest CT, both non-contrast and post-contrast (dissection protocol), revealed air in the vicinity of the left atrial appendage, thickening of the esophagus, and a clear tract of air extending towards the left atrium. The post-contrast study distinctly showed a fistulous connection from the esophagus to the left inferior pulmonary vein with surrounding inflammation. A subsequent head CT showed subtle areas of increased attenuation at the gray-white junction, consistent with neurologic insults.
Key takeaways
Atrioesophageal fistula is a rare but often catastrophic complication of left atrial ablation for atrial fibrillation, typically associated with poor outcomes and high mortality. Imaging findings can be subtle but are crucial for early diagnosis. A transesophageal echocardiogram (TEE) is absolutely contraindicated if this condition is suspected, as it risks massive air embolism. These fistulas can be intermittent, complicating diagnosis. This patient remarkably had a positive outcome, recovering with minimal residual neurological deficits after urgent surgical repair.
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