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. 2013 Nov;10(11):1591-7.
doi: 10.1016/j.hrthm.2013.08.012. Epub 2013 Aug 13.

Clinical outcomes after repair of left atrial esophageal fistulas occurring after atrial fibrillation ablation procedures

Sheldon M Singh  1 , Andre d'Avila, Steve K Singh, Paul Stelzer, Eduardo B Saad, Allan Skanes, Arash Aryana, Jason S Chinitz, Robert Kulina, Marc A Miller, Vivek Y Reddy
Affiliations

Clinical outcomes after repair of left atrial esophageal fistulas occurring after atrial fibrillation ablation procedures

Sheldon M Singh et al. Heart Rhythm. 2013 Nov.

Abstract

Background: The initial experience with left atrial esophageal fistula (LAEF) secondary to atrial fibrillation (AF) ablation procedures revealed a near-universal mortality. A comprehensive description of the principles of LAEF repair in the modern era and its resulting impact on morbidity and mortality are lacking in the literature.

Objective: To describe the presentation, surgical management, and outcomes of patients with LAEF.

Methods: A retrospective cohort analysis of 29 patients was performed, including previously unpublished cases of surgically repaired LAEF from 4 institutions (n = 6), and all published cases of surgically repaired (n = 16) or stented (n = 7) LAEF.

Results: The mean age was 55 ± 13 years, and 75% were men who were undergoing radiofrequency energy catheter ablation (n = 26), cryoablation (n = 1), high-intensity focused ultrasound ablation (n = 1), and surgical mini-MAZE procedure (n = 1) and presented 30 ± 12 days postablation procedure. Overall, 55% of the patients receiving an intervention for LAEF died (41% surgical repair; 100% stent). Patients who did not receive primary esophageal repair were more likely to experience postoperative complications, including mediastinitis, need for percutaneous endoscopic gastrostomy (PEG) feeds, esophageal stent, or death (P = .05). In addition, interposing tissue between the repaired esophagus and the left atrium resulted in fewer postoperative complications (P = .02).

Conclusions: While improved relative to initial reports, mortality associated with LAEF remains high after corrective intervention. Primary esophageal repair with the placement of tissue between the repaired esophagus and the left atrium may result in lower morbidity and mortality.

Keywords: AF; Adverse events; Atrial fibrillation; CPB; CT; Cardiothoracic surgery; Complication; EGD; Esophageal injury; Fistula; LA; LAEF; PEG; TEE; atrial fibrillation; cardiopulmonary bypass; computed tomography; esophagogastroduodenoscopy; left atrial esophageal fistula; left atrium/atrial; percutaneous endoscopic gastrostomy; transesophageal echocardiogram.

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