Acute Stroke After Upper Endoscopy in a Patient With a Suspected Atrioesophageal Fistula

Namisha Thapa

Yumi Ando

Silvio de Melo

^{Department of Medicine, Oregon Health & Science University, Portland, OR}

^{Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, OR}

^{Corresponding author.}

Correspondence: Silvio W. de Melo Jr, MD, FACG, AGAF, Oregon Health & Science University, 3303 SW Bond Ave, Portland, OR 97239 (ude.usho@olemed).

Received 2019 Jul 9; Accepted 2019 Sep 23.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

ABSTRACT

Atrioesophageal fistula (AEF) is a rare complication of atrial fibrillation ablation. We present a man with sepsis and frank hematemesis 3 weeks after atrial fibrillation ablation. Thoracic computed tomography showed no definitive evidence of AEF. He underwent esophagogastroduodenoscopy and subsequently developed an embolic stroke. In the operating room, he was found to have AEF. This case highlights the importance of maintaining a high index of suspicion for AEF because of its nonspecific presentation and difficulty in diagnosing with imaging or endoscopy. Once AEF is suspected, esophagogastroduodenoscopy should be avoided because of the risk of precipitating embolic events.

ABSTRACT

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