title: An avoidable cause of cardioembolic stroke.
abstract: Left Atrial Ablation for Atrial Fibrillation is safe and effective for most patients. However a rare complication is thermal damage to the integrity of the normal physical barriers between the left atrium and the adjacent oesophagus due to the ablation process. This can lead to formation of an Atrial-Oesophageal fistula with sepsis, haemorrhage and systemic cardioembolism occurring even up to 2 months post procedure. The presentation is similar to endocarditis but localised instrumentation specifically Transoesophageal echocardiography (TOE) can provoke systemic cardioembolism. This is an important differential in those presenting acutely with a Pyrexia of Unknown Origin or endocarditis-like picture within 2 months of ablation therapy.
authors.affiliation: Consultant Stroke and Acute Physician, Northampton General Hospital.
authors.forename: Declan
authors.initials: D
authors.lastname: O'Kane
authors.affiliation: Consultant Stroke Physician, East and North Hertfordshire NHS Trust.
authors.forename: Aparna
authors.initials: A
authors.lastname: Pusalkar
authors.affiliation: Consultant, FRCR, MBBS Cardiothoracic Radiologist East and North Hertfordshire NHS Trust.
authors.forename: Will
authors.initials: W
authors.lastname: Topping
authors.affiliation: East and North Hertfordshire NHS Trust.
authors.forename: Oliver
authors.initials: O
authors.lastname: Spooner
authors.affiliation: East and North Hertfordshire NHS Trust.
authors.forename: Emma
authors.initials: E
authors.lastname: Roantree
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005500:Follow-Up Studies; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology*; D008297:Male