Esophagopericardial fistula from thermal injury after local abnormal ventricular activity arrhythmia ablation therapy: endoscopic findings and therapy.
A 61-year-old man with a long history of coronary artery disease, who had undergone drug-eluting stent placement in 2018, was receiving long-term antiplatelet therapy with aspirin and ticagrelor, had ischemic cardiomyopathy (ejection fraction 40%), and had scar-related nonsustained ventricular tachycardia from remote cocaine use, had been treated with ablation therapy in 2013 and had received an implantable cardioverter defibrillator in 2014, recently experienced leukocytosis, pyrexia, hypotension, and dyspnea 12 days after undergoing epicardial and endocardial inferolateral wall local abnormal ventricular activity mapping ablation and scar homogenization in 2019 to treat nonsustained ventricular tachycardia refractory to amiodarone therapy. A transthoracic echocardiogram and chest CT revealed moderate fibrinous pericardial effusion with air, and the patient underwent subxiphoid pericardial window and drainage for pericardial tamponade, resulting in drainage of several hundred milliliters of cloudy fluid. CT of the chest was performed after drainage ( A ), and Staphylococcus epidermidis was isolated from the pericardial fluid culture. The patient received intravenous antibiotic therapy for purulent pericarditis.
Edhi AI, Gjeorgjievski M, Kulesza G, Cappell MS. Esophagopericardial fistula from thermal injury after local abnormal ventricular activity arrhythmia ablation therapy: endoscopic findings and therapy. Gastrointest Endosc. 2020 Mar;91(3):709-711. doi: 10.1016/j.gie.2019.09.023. Epub 2019 Sep 24. PMID: 31560876.