Author + information
- Received September 28, 2016
- Accepted October 6, 2016
- Published online June 19, 2017.
- Osama T. Niazi, DOa,∗ (, )
- Bryan Broderick, BAa,
- Sarah Timmapuri, MDb,
- Pranaychandra Vaidya, MDb,
- Jose Serranoc,
- Diana Castro, MDc,
- Ciaran Mannion, MDc and
- Ruchi Sethi, MDb
- aDivision of Cardiology, Rutgers New Jersey Medical School, Newark, New Jersey
- bDivision of Cardiology, Hackensack University Medical Center, Hackensack, New Jersey
- cDepartment of Pathology, Hackensack University Medical Center, Hackensack, New Jersey
- ↵∗Address for correspondence:
Dr. Osama T. Niazi, Division of Cardiology, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, New Jersey 07103.
A 64-year-old man with a history of persistent atrial fibrillation presented 2 weeks after pulmonary vein isolation radiofrequency ablation (RFA) with progressive weakness, altered mental status, and seizures. The patient underwent unsuccessful RFA for atrial fibrillation at an outside facility and, since going home, had progressive weakness and mid-sternal chest pain. In the emergency department, a computed tomographic scan of the head was performed that revealed air emboli involving the perimedullary veins in the region of the basal ganglia involving the right hemisphere (Figure 1A). A computed tomographic scan of the chest revealed a posterior mediastinal hematoma containing a few small foci of air immediately posterior to the left atrium and left pulmonary veins (Figure 1B). The patient was referred for emergent hyperbaric oxygen therapy; however, his condition rapidly declined with 90% infarction of his right hemisphere and central herniation. The patient had “do-not-resuscitate” status as noted by his family and subsequently died from his cerebral insult. An autopsy revealed a large thrombus in the esophagus with a 9-mm defect in the anterior wall of the esophagus (Figures 2A and 2B) associated with a hemorrhagic mass extending to the posterior left atrial wall. Atrial-esophageal fistula is a rare complication of RFA for left atrial arrhythmias. Air emboli can occur in this setting, and the treatment of choice is hyperbaric oxygen with repair of the underlying defect.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 28, 2016.
- Accepted October 6, 2016.
- 2017 American College of Cardiology Foundation