title: Haemorrhagic cerebral air embolism from an atrio-oesophageal fistula following atrial fibrillation ablation.
abstract: We report the case of a man found unconscious three weeks following atrial fibrillation (AF) ablation. Cranial and thoracic imaging demonstrated multiple areas of pneumo-embolic infarction secondary to an atrio-oesophageal fistula (AEF). AEF is a recognised, but rare, complication of AF ablation.(1-8) Early recognition is critical as the mortality is 100% without surgical intervention. We consider the postulated mechanisms of AEF formation, the spectrum of clinical presentation, investigations and treatment.
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Koa-Wing
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jamil-Copley
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Ariff
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Kojodjojo
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: P B
authors.initials: PB
authors.lastname: Lim
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Whinnett
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Rajakulendran
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Malhotra
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Lefroy
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: N S
authors.initials: NS
authors.lastname: Peters
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: D W
authors.initials: DW
authors.lastname: Davies
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK p.kanagaratnam@imperial.ac.uk.
authors.forename: P
authors.initials: P
authors.lastname: Kanagaratnam
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology; D004947:Esophagus; D017809:Fatal Outcome; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011859:Radiography
keywords: atrial fibrillation ablation; atrio-oesophageal fistula