Teaching NeuroImages: Neurologic deterioration after atrial fibrillation ablation

摘要

A 68-year-old man presented with fever and altered mental status 4 weeks following an ablation procedure for atrial fibrillation (AF). Head CT revealed multifocal embolic-appearing infarcts. Chest CT revealed air in the left atrial appendage (figure). These findings led to a diagnosis of cardioembolic stroke secondary to septic emboli from an atrioesophageal fistula (AEF). AEF may occur in up to 0.25% of AF ablations and manifests 1-6 weeks postprocedure with fever, stroke, and/or end-organ damage from septic emboli. 1Transthoracic echocardiogram and chest CT should be considered to rule out AEF in patients with neurologic decline following AF ablation.