# Self-sealing atrio-oesophageal fistula as a complication of pulmonary vein isolation: a case report

## TL;DR

A rare case of a self-sealing atrio-oesophageal fistula following heart ablation surgery is reported, highlighting the importance of early diagnosis using advanced imaging techniques.

## Contribution

This case report adds to the limited clinical literature on AEF complications following pulmonary vein ablation and emphasizes diagnostic approaches.

## Key findings

- A 69-year-old patient with atrial fibrillation developed AEF after pulmonary vein ablation.
- Contrast-enhanced chest CT is recommended as the gold standard for diagnosing AEF.
- Pneumocephalus and acute infarcts in brain imaging may indicate AEF.

## Abstract

Atrio-oesophageal fistulas (AEFs) are an uncommon complication of pulmonary vein ablation, and its diagnosis is challenging. Multidisciplinary interventions and diagnostic imaging are usually required and may play a role in the initial assessment.

A 69-year-old female with atrial fibrillation who had undergone recent pulmonary vein ablation consulted with unspecific symptoms and sudden hemiparesis. Brain imaging showed pneumocephalus and acute infarcts. Chest computed tomography (CT) was highly suspicious for AEF. Surgical exploration revealed a swollen mediastinum attached to the right inferior pulmonary vein.

Non-specific symptoms after pulmonary vein ablation should prompt the suspicion of complications. In the presence of fever or neurological deficit, AEF must be suspected and assessed with a contrast-enhanced chest CT, which has become the gold standard. In brain imaging, pneumocephalus and multiple punctate acute infarcts might also indicate the presence of this complication.