CHEST Guidelines-A-71-Year-Old-Man-With-Gas-Accumulation-in-the-Lef

A-71-Year-Old-Man-With-Gas-Accumulation-in-the-Lef

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The case study discusses a 71-year-old male patient with a history of atrial fibrillation who experienced sudden unconsciousness and was admitted to the hospital. He had undergone radiofrequency ablation for atrial fibrillation four weeks prior and was on anticoagulant therapy with rivaroxaban. On arrival, the patient showed signs of acute myocardial infarction, significant infection indicators, and abnormal neurological signs, but no significant coronary artery issues were identified through imaging. Notably, gas accumulation was detected in the left atrium, and metagenomic sequencing identified bacteria typically found in the oral cavity.<br /><br />The key finding was the presence of an atrio-esophageal fistula (AEF), a rare yet severe complication following atrial fibrillation ablation. AEF occurs 1 to 6 weeks post-ablation with symptoms like fever, neurological dysfunction, and chest pain, often due to thermal injury from the procedure. In this case, a contrast-enhanced chest CT revealed specific abnormalities associated with AEF, such as gas accumulation in the left atrium and changes in the esophageal wall.<br /><br />Management of AEF usually involves surgical intervention, including esophageal and atrial repair, to improve survival chances. Unfortunately, despite intensive care efforts, the patient developed worsening neurological symptoms indicative of air embolism, leading the family to withdraw further medical interventions.<br /><br />The report emphasizes the rarity and lethality of AEF post-ablation, recommending high suspicion with simultaneous infective, cardiac, and neurological symptoms after the procedure. Prompt diagnostic imaging, like contrast-enhanced chest CT, and timely surgical intervention significantly impact patient outcomes, while procedures like intubation should be avoided due to potential complications. The study stresses the importance of recognizing these symptoms early to initiate appropriate treatment.

Keywords

atrial fibrillation

radiofrequency ablation

atrio-esophageal fistula

anticoagulant therapy

rivaroxaban

myocardial infarction

neurological symptoms

contrast-enhanced CT

surgical intervention

air embolism