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Canadian Journal of Cardiology

Coronary Air Embolism Associated With Atrioesophageal Fistula After Ablation of Atrial Fibrillation

Published:August 12, 2013DOI:https://doi.org/10.1016/j.cjca.2013.05.011

      Abstract

      A 68-year-old man presented with multiple embolic strokes and sepsis 50 days after catheter ablation of atrial fibrillation. Cardiac computed tomography scan demonstrated an atrioesophageal fistula at the left atrial posterior wall and hypermobile materials with hypoattenuating lesions in the left atrium. On the 12th hospital day, he presented with acute ST-elevation in the inferior leads. A bedside echocardiogram revealed unusually high myocardial echogenecity and akinesia on the right coronary artery territory. These findings disappeared within a few minutes. This case shows characteristic images of coronary air embolism in gas-containing endocarditis caused by atrioesophageal fistula after catheter ablation of atrial fibrillation.

      Résumé

      Un homme âgé de 68 ans a souffert de multiples accidents vasculaires cérébraux d’origine embolique et d’une sepsie 50 jours après l’ablation par cathéter de la fibrillation auriculaire. La tomodensitométrie cardiaque a démontré une fistule atrio-œsophagienne à la paroi postérieure de l’oreillette gauche et des matières hypermobiles avec hypoatténuation des lésions de l’oreillette gauche. Au 12e jour d’hospitalisation, il a subi un sus-décalage aigu du segment ST dans les dérivations inférieures. Un échocardiogramme au chevet du patient a révélé une échogénicité et une akinésie myocardique anormalement importante dans le territoire droit de l’artère coronaire. Ces résultats sont disparus en quelques minutes. Ce cas montre des images caractéristiques d’embolie gazeuse coronarienne dans l’endocardite contenant des gaz causée par la fistule atrio-œsophagienne après l’ablation par cathéter de la fibrillation auriculaire.
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      References

        • Prasad A.
        • Banerjee S.
        • Brilakis E.S.
        Hemodynamic consequences of massive coronary air embolism.
        Circulation. 2007; 115: e51-e53
        • Lamm G.
        • Auer J.
        • Punzengruber C.
        • Ng C.K.
        • Eber B.
        Intracoronary air embolism in open heart surgery—an uncommon source of myocardial ischaemia.
        Int J Cardiol. 2006; 112: e85-e86
        • Pappone C.
        • Oral H.
        • Santinelli V.
        • et al.
        Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation.
        Circulation. 2004; 109: 2724-2726
        • Tancevski I.
        • Hintringer F.
        • Stuehlinger M.
        • et al.
        Atrioesophageal fistula after percutaneous transcatheter ablation of atrial fibrillation.
        Circulation. 2012; 125: 966
        • Cappato R.
        • Calkins H.
        • Chen S.A.
        • et al.
        Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.
        Circ Arrhythm Electrophysiol. 2010; 3: 32-38