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Case Reports
. 2016 Feb;7(1):36-45.
doi: 10.14740/cr454e. Epub 2016 Feb 20.

Management of Atrio-Esophageal Fistula Following Left Atrial Ablation

Tariq Yousuf  1 , Hesam Keshmiri  1 , Zachary Bulwa  2 , Jason Kramer  2 , Hafiz Muhammad Sharjeel Arshad  1 , Rasha Issa  1 , Daniel Woznicka  1 , Paul Gordon  3 , Pierre Abi-Mansour  4
Affiliations
Case Reports

Management of Atrio-Esophageal Fistula Following Left Atrial Ablation

Tariq Yousuf et al. Cardiol Res. 2016 Feb.

Abstract

Currently, no guidelines have been established for the treatment of atrio-esophageal fistula (AEF) secondary to left atrial ablation therapy. After comprehensive literature review, we aim to make suggestions on the management of this complex complication and also present a case series. We performed a review of the existing literature on AEF in the setting of atrial ablation. Using keywords atrial fibrillation, atrial ablation, fistula formation, atrio-esophageal fistula, complications, interventions, and prognosis, a search was made using the medical databases PUBMED and MEDLINE for reports in English from 2000 to April 2015. A statistical analysis was performed to compare the three different intervention arms: medical management, stent placement and surgical intervention. The results of our systematic review confirm the high mortality rate associated with AEF following left atrial ablation and the necessity to diagnose atrio-esophageal injury in a timely manner. The mortality rates of this complication are 96% with medical management alone, 100% with stent placement, and 33 % with surgical intervention. Atrio-esophageal injury and subsequent AEF is an infrequent but potentially fatal complication of atrial ablation. Early, prompt, and definitive surgical intervention is the treatment of choice.

Keywords: Arrhythmia; Atrial ablation; Atrial fibrillation; Atrio-esophageal fistula.

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Figures

Figure 1
Figure 1
X-ray esophagus with gastrografin showing sinus tracts extending from anterior aspect of esophagus.
Figure 2
Figure 2
X-ray esophagus with gastrografin showing two sinus tracts extending from anterior aspect of esophagus at level T7.
Figure 3
Figure 3
CTA of the chest and abdomen identified esophageal perforation with a fistulous tract to the left atrium.
Figure 4
Figure 4
Esophagogram showing extravasation of contrast from posterolateral aspect of esophagus.
Figure 5
Figure 5
Two-centimeter defect in the esophagus.
Figure 6
Figure 6
Esophagus wrapped circumferentially with latissimus flap.
See this image and copyright information in PMC

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