Suspected Atrioesophageal Fistula After Atrial Fibrillation Ablation

CASE SUMMARY: Blood cultures yielded Streptococcus salivarius/anginosus. Broad-spectrum antibiotics were initiated and later escalated to include gram-positive bacteria and anaerobic bacterial coverage for presumed polymicrobial infection. The patient was kept nothing by mouth and started on total parenteral nutrition. Computed tomography found an outpouching of the posterior left atrial wall, raising concern for AEF. Repeat computed tomography demonstrated no abnormality, and serial blood cultures remained sterile. The patient exhibited nearly full clinical recovery after 6 weeks of antibiotic therapy. DISCUSSION: Diagnosis and treatment of AEF remains a significant clinical challenge. This case highlights conservative management of suspected AEF through antibiotic therapy and diet modification. TAKE-HOME MESSAGE: Conservative treatment of suspected AEF may be possible with early recognition of symptomatic presentation.