Abstract 201: Atrial‐Esophageal Fistula Associated Food Embolism

A 70‐year‐old man underwent pulmonary vein isolation (PVI) ablation for atrial fibrillation two months prior to presentation. He unfortunately then presented with new onset aphasia, right hemiparesis, and fever. MRI Brain demonstrated multifocal cortical infarcts in the left frontoparietal region and right frontal region (Figure 1, Panel A and B). Routine stroke and medical evaluation including blood cultures, cerebrospinal fluid studies, CT Chest, and transthoracic echocardiogram were unremarkable for an explanatory etiology for his strokes including no clear infectious etiology. Due to his recent PVI ablation, there was a suspicion for the possibility of an atrial‐esophageal fistula with subsequent food embolism. The patient underwent an exploratory thoracotomy, with discovery of an atrial‐esophageal fistula and subsequent repair (Figure, Panel C). He overall did well and with aggressive rehabilitation. Repeat MRI showed significant improvement of edema with residual encephalomalacia. He regained significant functioning and is left with residual mild right hemiparesis.