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Left Atrial to Esophageal Fistula: A Case Report and Literature Review
Patient: Male, 57 Final Diagnosis: Left atrial to esophageal fistula Symptoms: Chest pain • syncope Medication: — Clinical Procedure: — Specialty: Cardiology OBJECTIVE: Unusual clinical course BACKGROUND: Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablatio...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094614/ https://www.ncbi.nlm.nih.gov/pubmed/27803496 http://dx.doi.org/10.12659/AJCR.899878 |
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author | Khan, Muhammad Yasir Siddiqui, Waqas Javed Iyer, Praneet S. Dirweesh, Ahmed Karabulut, Nigahus |
author_facet | Khan, Muhammad Yasir Siddiqui, Waqas Javed Iyer, Praneet S. Dirweesh, Ahmed Karabulut, Nigahus |
author_sort | Khan, Muhammad Yasir |
collection | PubMed |
description | Patient: Male, 57 Final Diagnosis: Left atrial to esophageal fistula Symptoms: Chest pain • syncope Medication: — Clinical Procedure: — Specialty: Cardiology OBJECTIVE: Unusual clinical course BACKGROUND: Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablation (RFA) for atrial fibrillation and is associated with high mortality. Clinical features can be nonspecific and include fever, dysphagia, upper gastrointestinal (GI) bleeding, sepsis, and embolic stroke a after recent history of RFA for atrial fibrillation. CASE REPORT: A 57-year-old Caucasian male was brought to the emergency department (ED) by his family because of an altered mental status. He had undergone a radiofrequency ablation for paroxysmal atrial fibrillation three weeks earlier. Several hours after admission to the ED, the patient transiently became unresponsive and had a right sided hemiplegia. A brain MRI revealed multiple cerebral infarcts. On the following day, the patient had an episode of melena, and an esophagogastroduodenoscopy (EGD) was performed which did not reveal any source of bleeding. While the patient was being monitored in the intensive care unit (ICU), he had an episode of hematemesis and went into cardiac arrest from which he was successfully resuscitated and transferred to another facility. He had another EGD, which uncovered a flap of mucosa covering the lower third of his esophagus and a 1 cm fistulous opening was seen with fresh blood oozing out of it. The patient had another cardiac arrest during the endoscopy and died despite all measures. CONCLUSIONS: We present this case to stress the importance of early diagnosis of LAEF. LAEF can be fatal if diagnosis is delayed or missed. Early surgical intervention can reduce LAEF morbidity and mortality. Newer diagnostic modalities such as endoscopic ultrasound (EUS) can be helpful in cases where conventional imaging is unclear. |
format | Online Article Text |
id | pubmed-5094614 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-50946142016-11-10 Left Atrial to Esophageal Fistula: A Case Report and Literature Review Khan, Muhammad Yasir Siddiqui, Waqas Javed Iyer, Praneet S. Dirweesh, Ahmed Karabulut, Nigahus Am J Case Rep Article Patient: Male, 57 Final Diagnosis: Left atrial to esophageal fistula Symptoms: Chest pain • syncope Medication: — Clinical Procedure: — Specialty: Cardiology OBJECTIVE: Unusual clinical course BACKGROUND: Left atrial to esophageal fistula (LAEF) is a rare fatal complication of radiofrequency ablation (RFA) for atrial fibrillation and is associated with high mortality. Clinical features can be nonspecific and include fever, dysphagia, upper gastrointestinal (GI) bleeding, sepsis, and embolic stroke a after recent history of RFA for atrial fibrillation. CASE REPORT: A 57-year-old Caucasian male was brought to the emergency department (ED) by his family because of an altered mental status. He had undergone a radiofrequency ablation for paroxysmal atrial fibrillation three weeks earlier. Several hours after admission to the ED, the patient transiently became unresponsive and had a right sided hemiplegia. A brain MRI revealed multiple cerebral infarcts. On the following day, the patient had an episode of melena, and an esophagogastroduodenoscopy (EGD) was performed which did not reveal any source of bleeding. While the patient was being monitored in the intensive care unit (ICU), he had an episode of hematemesis and went into cardiac arrest from which he was successfully resuscitated and transferred to another facility. He had another EGD, which uncovered a flap of mucosa covering the lower third of his esophagus and a 1 cm fistulous opening was seen with fresh blood oozing out of it. The patient had another cardiac arrest during the endoscopy and died despite all measures. CONCLUSIONS: We present this case to stress the importance of early diagnosis of LAEF. LAEF can be fatal if diagnosis is delayed or missed. Early surgical intervention can reduce LAEF morbidity and mortality. Newer diagnostic modalities such as endoscopic ultrasound (EUS) can be helpful in cases where conventional imaging is unclear. International Scientific Literature, Inc. 2016-11-02 /pmc/articles/PMC5094614/ /pubmed/27803496 http://dx.doi.org/10.12659/AJCR.899878 Text en © Am J Case Rep, 2016 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) |
spellingShingle | Article Khan, Muhammad Yasir Siddiqui, Waqas Javed Iyer, Praneet S. Dirweesh, Ahmed Karabulut, Nigahus Left Atrial to Esophageal Fistula: A Case Report and Literature Review |
title | Left Atrial to Esophageal Fistula: A Case Report and Literature Review |
title_full | Left Atrial to Esophageal Fistula: A Case Report and Literature Review |
title_fullStr | Left Atrial to Esophageal Fistula: A Case Report and Literature Review |
title_full_unstemmed | Left Atrial to Esophageal Fistula: A Case Report and Literature Review |
title_short | Left Atrial to Esophageal Fistula: A Case Report and Literature Review |
title_sort | left atrial to esophageal fistula: a case report and literature review |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094614/ https://www.ncbi.nlm.nih.gov/pubmed/27803496 http://dx.doi.org/10.12659/AJCR.899878 |
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