title: Cerebral air emboli with atrial-esophageal fistula following atrial fibrillation ablation: a case report and review.
abstract: BACKGROUND
  Atrial-esophageal fistula (AEF) is a rare and early complication of radiofrequency ablation for medically refractory atrial fibrillation, but has devastating consequences when the diagnosis is delayed or difficult to make.
  
  
  METHODS
  Single case in a neurosciences critical care center.
  
  
  RESULTS
  A 69-year-old man with significant cardiac and neurologic medical history who underwent atrial fibrillation ablation 50 days prior to admission to the neurocritical care unit presented with acute left-sided weakness and gram-positive bacterial sepsis. This is an exceptional case discussing the need for early detection of AEF presenting with sepsis, neurologic deficit along with complicated decision-making in the neurocritical care setting. His hospital course was complicated by acute stroke, left ventricular (LV) aneurysm with thrombus, gastrointestinal (GI) bleed discovered to be from left atrial esophageal fistula, and subsequent cerebral air emboli leading to death.
  
  
  CONCLUSIONS
  This is the most delayed presentation of AEF following atrial fibrillation ablation reported in the literature to date. We emphasize the need for awareness of this complication even after such an unexpected time-frame postprocedure as well as the unintended complications of cerebral air emboli following upper endoscopy.
authors: Department of Neurology, University of Utah, Salt Lake City, UT, USA.
authors: K F
authors: KF
authors: French
authors: C
authors: C
authors: Garcia
authors: J J
authors: JJ
authors: Wold
authors: R E
authors: RE
authors: Hoesch
authors: H K
authors: HK
authors: Ledyard
keywords: AEF; atrial esophageal fistula; atrial fibrillation; cerebral air emboli; left ventricular aneurysm
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