Coronary air embolism associated with atrioesophageal fistula after ablation of atrial fibrillation.
A 68-year-old man presented with multiple embolic strokes and sepsis 50 days after catheter ablation of atrial fibrillation. Cardiac computed tomography scan demonstrated an atrioesophageal fistula at the left atrial posterior wall and hypermobile materials with hypoattenuating lesions in the left atrium. On the 12th hospital day, he presented with acute ST-elevation in the inferior leads. A bedside echocardiogram revealed unusually high myocardial echogenecity and akinesia on the right coronary artery territory. These findings disappeared within a few minutes. This case shows characteristic images of coronary air embolism in gas-containing endocarditis caused by atrioesophageal fistula after catheter ablation of atrial fibrillation.
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Chi Young
CY
Shim
Seung-Yul
SY
Lee
Hui-Nam
HN
Pak
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D004618:Embolism, Air / Q000175:diagnosis / Q000209:etiology*; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology*; D005402:Fistula / Q000175:diagnosis / Q000209:etiology*; D005500:Follow-Up Studies; D006325:Heart Atria; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D014057:Tomography, X-Ray Computed