Sanoja I A
Oregon Health and Science University, Portland, OR, USA.
Case Rep Crit Care. 2023 Apr 4;2023:3930221. doi: 10.1155/2023/3930221. eCollection 2023.
A 66-year-old female with a history of radiofrequency ablation for atrial fibrillation presented with hematemesis and fever. A CT chest revealed an atrio-esophageal fistula (AEF) and a CT head showed bilateral septic emboli. Blood cultures were positive for . She underwent primary repair of the atrial defect on cardiopulmonary bypass where a large atrial vegetation was retrieved, followed by a right thoracotomy with the closure of the esophageal defect the next day. She was discharged to a rehabilitation facility after 18 days of hospital stay with a 6 weeks antibiotics plan. The incidence of AEF following ablation procedures has been estimated at 0.01 to 0.04%, and the pathogenesis is linked to direct tissue and vagus nerve injury. The most common clinical findings are fever and neurologic deficits. CT chest is the best diagnostic modality. CT head might demonstrate embolic phenomena and TTE can show vegetation. Early surgical intervention, even in an unstable patient, is paramount for survival.
一名有房颤射频消融病史的66岁女性出现呕血和发热。胸部CT显示心房食管瘘（AEF），头部CT显示双侧脓毒性栓子。血培养结果为阳性。她在体外循环下接受了心房缺损的一期修复，术中取出了一个大的心房赘生物，第二天进行了右胸切开术以闭合食管缺损。住院18天后，她带着为期6周的抗生素治疗方案被转至康复机构。消融术后AEF的发生率估计为0.01%至0.04%，其发病机制与直接组织损伤和迷走神经损伤有关。最常见的临床表现是发热和神经功能缺损。胸部CT是最佳诊断方式。头部CT可能显示栓塞现象，经胸超声心动图（TTE）可显示赘生物。即使对于病情不稳定的患者，早期手术干预对生存至关重要。
