Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports

Abstract

Background: Atrioesophageal fistula (AEF) is a rare but serious adverse event of atrial fibrillation (AF) ablation. Objective: To identify the clinical characteristics of AEF following ablation procedures for AF and determine the associated mortality. Methods: A systematic review of observational cases of AEF following ablation procedures for AF was performed following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) statement protocol. Results: 53 cases were identified. Mean age was 54 +/- 13 years; 73% (39/53) of cases occurred in males. Mean interval between procedure and presentation was 20 +/- 12 days, ranging from 2 to 60 days. AEF was observed in 12 patients who underwent surgical radiofrequency ablation (RFA) and in 41 patients with percutaneous RFA. Fever was the most common presenting symptom (n= 44) followed by neurological deficits (n= 27) and haematemesis (n= 19). CT of the chest (n= 27) was the preferred diagnostic test. Patients who did not receive a primary esophageal repair were more likely to have a deadly outcome (34% vs 83%; p< 0.05). No difference in mortality rate was found between patients who underwent surgical RFA when compared with percutaneous RFA (58% vs 56%; p= 0.579). No association was found between onset of symptoms and mortality (19 +/- 10 vs 23 +/- 14 days; p= 0.355). Conclusions: AEF following ablation procedures for AF is a serious complication with high mortality rates. Presenting symptoms most often include a triad of fever, neurological deficit and/or haematemesis within 60 days of procedure. The preferred diagnostic test is CT of the chest. The treatments of choice is surgical repair.