Novel videoendoscopy demonstrating irregular, pulsatile GI bleeding from left atrium through an esophageal fistula after pulmonary vein isolation and catheter ablation for atrial fibrillation (with video)

Abstract

A 63-year-old woman was seen with hematemesis, melena, acute decline in hemoglobin level (from 13.9 to 10.9 g/dL), profound tachycardia (122 beats per minute, irregularly irregular pulse), and blood pressure of 140/72 mm Hg 1 month after pulmonary vein isolation and catheter ablation (performed for sotalol-refractory paroxysmal atrial fibrillation) with the use of extremely high ablative energy because of complex electrophysiologic anatomy with failure to convert to sinus rhythm. The patient was administered long-term dabigatran (she was allergic to warfarin) for atrial fibrillation.