We present the case of a 67-year-old patient who presented to the ICU with fever and neurological deficits, mimicking a cerebrovascular accident, due to a left atrial oesophageal fistula (LAOF) after surgical radiofrequency ablation for atrial fibrillation. Due to the relative rarity of the complication and the diverse clinical presentation of this condition, both the diagnosis and management of LAOF is challenging.