A rare complication following radiofrequency ablation

Area of Science:

• Cardiology
• Gastroenterology
• Infectious Diseases

Background:

• Radiofrequency ablation (RFA) is a common treatment for atrial fibrillation.
• Atrial-oesophageal fistula (AOF) is a rare but life-threatening complication following RFA.
• High mortality rates (67-100%) are associated with AOF.

Observation:

• A healthy man in his 40s developed sepsis and Streptococcus viridans bacteraemia 14 days post-RFA.
• The patient presented with a Glasgow Coma Scale of 5/15.
• AOF diagnosis was challenging due to misdiagnosis as infective endocarditis.

Findings:

• AOF formation post-RFA requires a high index of suspicion.
• Prompt diagnosis is critical due to rapid progression and high mortality.
• No established mortality predictors exist.

Implications:

• Emphasizes the need for vigilance for AOF in post-RFA patients with sepsis symptoms.
• Highlights the importance of emergent operative intervention and prolonged antibiotic therapy for survival.
• Suggests improved diagnostic strategies are needed to avoid misdiagnosis, such as confusing AOF with infective endocarditis.