DOI: 10.12890/2025_005102

Pus in the pericardium: a pericardial-oesophageal fistula with cardiac tamponade after ablation for atrial fibrillation

Authors

  • Taha Mansoor Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
  • Nahal Massoudi Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
  • Anandbir Bath Ascension Borgess Hospital, Kalamazoo, USA
  • Matthew Kelly Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
  • Santhosh Koshy Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA; Ascension Borgess Hospital, Kalamazoo, USA
  • Armand Tanase Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA; Ascension Borgess Hospital, Kalamazoo, USA

taha.mansoor@wmed.edu

Keywords

Pericardial-oesophageal fistula, atrial-pericardial fistula, ablation, atrial fibrillation

Abstract

Background: Pericardial/atrial oesophageal fistula (PEF/AEF) is the most feared complication of cardiac atrial fibrillation (AF) ablation. Without urgent surgical treatment, most cases of this infrequent complication rapidly prove fatal.
Case report: We present an uncommon case of a 60-year-old male who had undergone an AF ablation 2 weeks prior and presented with chest pain. Following diagnosis and treatment of ST-elevation myocardial infarction (STEMI), a small pericardial effusion was noticed on computed tomography (CT) scan. Despite an initially reassuring hospital course, rapid decompensation and expansion of his purulent pericardial effusion led to his death within 24 hours of presentation. A post-mortem review of his CT imaging revealed an inconspicuous PEF.
Conclusions: It is essential to maintain a high suspicion of PEF/AEF in patients presenting after AF ablation with suggestive symptoms, such as fever, chest pain/odynophagia, and neurological deficits. CT chest is the most common diagnostic modality and surgical correction is the treatment of choice.

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References

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Published

2025-01-07

Issue

Vol. 12 No. 2 (2025)

Categories

How to Cite

1.
Mansoor T, Massoudi N, Bath A, Kelly M, Koshy S, Tanase A. Pus in the pericardium: a pericardial-oesophageal fistula with cardiac tamponade after ablation for atrial fibrillation. EJCRIM [Internet]. 2025 Jan. 7 [cited 2026 Nov. 4];12(2). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5102

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