Inbar Saporta, MD; Adithya Chennamadhavuni, MD; Michael J. Dolan, MD
A 75-year-old woman was admitted with fever, chills, altered mentation, and right-sided weakness. A month earlier, she had undergone catheter radiofrequency ablation for treatment of chronic atrial fibrillation. A magnetic resonance imaging scan of her brain revealed septic emboli with multiple bilateral cerebral and cerebellar infarcts, as well as extensive bilateral leptomeningeal enhancement. Blood cultures were positive for Streptococcus mitis, Rothia mucilaginosa, Streptococcus pneumonia, and Candida albicans, which suggested a connection between gastrointestinal and cardiovascular systems. A chest computed tomography scan with contrast showed a curvilinear low attenuation structure communicating between the esophagus and the left pulmonary vein—an atrioesophageal fistula. Ten days after admission, the patient died from multiple cerebral septic emboli secondary to atrioesophageal fistula following radiofrequency ablation.