Atrio-oesophageal fistula after thoracoscopic treatment of atrial fibrillation

Background An atrio-oesophageal fistula (AOF) is a rare but severe complication of radiofrequency ablation during videoassisted thoracoscopic pulmonary vein isolation (VATSPVI). Case description A 68-year-old man presented to the emergency department with reduced general wellbeing and a fever. Eight weeks prior he had undergone a VATS-PVI. Blood results revealed elevated inflammatory parameters, and blood cultures were positive for Streptococcus anginosus. A CT-scan demonstrated an air configuration in the left atrium. Shortly after this he developed a leftsided hemiparesis. As a cerebral air embolus due to an AOF was suspected, we decided to operate. The defects in the atrium and the oesophagus were closed primarily during open-heart surgery. Conclusion An AOF is a rare complication following a VATS-PVI. Patients often present with nonspecific symptoms like a fever. It is important to be alert of this complication after a VATS-PVI and to perform early diagnostic imaging.

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