Outcomes of Atrioesophageal Fistula Following Catheter Ablation of Atrial Fibrillation Treated with Surgical Repair versus Esophageal Stenting
- 17 February 2014
- journal article
- research article
- Published by Wiley in Journal of Cardiovascular Electrophysiology
- Vol. 25 (6), 579-584
- https://doi.org/10.1111/jce.12386
Abstract
Introduction Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies. Methods Nine patients with AEF post‐RFCA for AF were included in this study. AEF was diagnosed based on symptoms and chest CT imaging. Of the 9 patients, 5 received stents and 4 underwent surgical repair of fistula. Results AF ablation was performed under general anesthesia (n = 4) or conscious sedation (n = 5). During ablation, RF power was maintained between 25 and 35 Watts in areas close to the esophagus and energy delivery discontinued when esophageal temperature reached 38 °C. Seven patients underwent ablation with 3.5‐mm open‐irrigated catheter, 1 with 8‐mm nonirrigated catheter, and 1 had surgical epicardial ablation. Seven patients received proton pump inhibitor and sucralfate before and after procedure. AEF symptoms developed within 2–6 weeks from ablation. Esophageal stenting was performed in 5 patients (median age 58 years, median time from RFCA 4 weeks) and 4 underwent surgical repair (median age 54 years, median time from RFCA 4 weeks) within 2–4 hours from diagnosis. All 5 patients receiving stents died within 1 week of the procedure due to cerebral embolism, septic shock, or respiratory failure. On the other hand, the 4 patients that received surgical repair were alive at median follow‐up of 2.1 years (P = 0.005). Conclusions Esophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.Keywords
This publication has 27 references indexed in Scilit:
- Successful Management of Atrio-Esophageal Fistula after Cardiac Radiofrequency Catheter AblationThe Korean Journal of Thoracic and Cardiovascular Surgery, 2013
- Fatal course of esophageal stenting of an atrioesophageal fistula after atrial fibrillation ablationHeart Rhythm, 2011
- Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hoursScandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2011
- Atrial‐Esophageal Fistula after Atrial Radiofrequency Catheter AblationClinical Infectious Diseases, 2010
- Esophageal perforation: surgical, endoscopic and medical management strategiesCurrent Opinion in Gastroenterology, 2010
- Atrio‐oesophageal fistula: An emergent complication of radiofrequency ablationEmergency Medicine Australasia, 2009
- Complications in the Catheter Ablation of Atrial FibrillationCirculation Journal, 2009
- CT Radiographic FindingsJournal of Thoracic Imaging, 2007
- Temporary Esophageal Stenting Allows Healing of Esophageal Perforations Following Atrial Fibrillation Ablation ProceduresJournal of Cardiovascular Electrophysiology, 2006
- Atrio-Esophageal Fistula as a Complication of Percutaneous Transcatheter Ablation of Atrial FibrillationCirculation, 2004