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Case Reports
. 2019 Jul;19(4):331-333.
doi: 10.7861/clinmedicine.19-4-331.

Lessons of the month 1: Fatal oesophago-pericardial fistula with cerebral air embolism after elective atrial fibrillation ablation

Jonathan Dutton  1 , Marco Morosin  2 , Rita Fernandez-Garda  2 , Vladamir Anikin  2 , Ana Hurtado-Doce  2 , Nicholas Lees  2
Affiliations
Case Reports

Lessons of the month 1: Fatal oesophago-pericardial fistula with cerebral air embolism after elective atrial fibrillation ablation

Jonathan Dutton et al. Clin Med (Lond). 2019 Jul.

Abstract

Oesophago-pericardial fistula following any electrophysiological procedure is a rare, and potentially, life-threatening condition. Initial presentation can easily be misdiagnosed, as symptoms vary and are not specific. Echocardiography is an invaluable tool to diagnose and rule out complications. We present the case of a 68-year-old patient who developed an oesophago-pericardial fistula complicated with purulent pericarditis, sepsis and cerebral air embolism. In conclusion, this case report encourages physicians to use strategies that may help with early diagnosis and lead to potential lifesaving interventions.

Keywords: Cardiology; ablation; atrial fibrillation.

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Figures

Fig 1.
Fig 1.
(a) Intravenous contrast enhanced computed tomography thorax; demonstrating pneumopericardium. (b) Oesophago-gastroduodenos-copy: left atrium prompting into the oesophagus.
Fig 2.
Fig 2.
(a) Computed tomography thorax with oral contrast: opacification of the oesophagus with focal extravasation at the level of the right inferior pulmonary vein. (b) Computed tomography head: ischaemic infarcts with air embolism at grey-white matter interface.
See this image and copyright information in PMC

Comment in

  • Oesophago-pericardial fistula.
    Pope M, Gala ABE, Cox A, Betts T. Pope M, et al. Clin Med (Lond). 2019 Sep;19(5):431-432. doi: 10.7861/clinmedicine.19-5-431a. Clin Med (Lond). 2019. PMID: 31530708 Free PMC article. No abstract available.

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