A Sentinel Esophageal Bleeding Prior to Stroke as a Presentation of Atrio-Esophagel Fistula
Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
Heart Rhythm
Abstract
Background: 67-year-old male has a planned PVI with RFA for atrial fibrillation involving bilateral wide area circumferential ablation, left carina line, posterior left atrial linear box isolation. He also underwent separate CTI ablation for atrial flutter. He was discharged the next day on colchicine and omeprazole. On postprocedure day 7, he presented with melena and hemoglobin drop to 10.2 g/dl from 13.3 g/dl on discharge. He underwent endoscopy which revealed one cratered esophageal ulcer 35 cm from the incisors. The lesion was treated with epinephrine and hemostatic clips. CT chest with IV contrast was negative. He received blood the next day which brought his Hb to 8.3 g/dl. He was discharged with a Hb of 8.8 g/dl. He re-presented 10 days later with syncope, weakness and inability to move his bilateral legs and left arm with an NIHSS of 11. His initial imaging was negative. It was repeated with PO contrast during which he went unresponsive and was intubated. It revealed an AE fistula at the level of the lower left pulmonary vein with the esophageal clips in the thoracic cavity as seen in figure 1. Objective: To describe a case of AE fistula with an early bleeding presentation Methods: NA Results: NA Conclusion: In most cases, it is imperative to reassess with repeat imaging. CT chest with contrast is the modality of choice and this case highlights the importance of PO contrast to increase sensitivity. Post ablation endoscopies have revealed a high incidence of esophageal erosion in patients undergoing RF ablation and cryoballoon pulmonary vein isolation. Early recognition and intervention of AE fistula is critical to improved long term outcome of patients.
Volume
21
Issue
5S
First Page
S316
Recommended Citation
Sankar P, Khalil P, Williamson B. A sentinel esophageal bleeding prior to stroke as a presentation of atrio-esophageal fistula. Heart Rhythm. 2024 May;21(5S):S315. doi:10.1016/j.hrthm.2024.03.906
DOI
10.1016/j.hrthm.2024.03.906
Comments
Heart Rhythm Society Annual Meeting, May 16-19, 2024, Boston, MA