Surgical repair of an esophageal perforation after radiofrequency catheter ablation for atrial fibrillation

Abstract

Recent reports have described the incidence of atrioesophageal fistulas (AEF), often resulting in death, from radiofrequency (RF) catheter ablation of atrial fibrillation (AF).¹ Cases of esophageal perforation without concomitant AEF have not been described as extensively.¹ The precise mechanisms leading to esophageal injury after catheter ablation without involvement of the left atrium are not fully understood. The surgical approach to treat esophageal perforation is strongly recommended.² However, a unified surgical treatment approach has not yet been established. We describe a case of successful surgical repair of an esophageal perforation after ablation using surgical repair in combination with an omental wrap.

Keywords: Atrial fibrillation; Radiofrequency catheter ablation; Surgery.

Fig. 1

Electroanatomical map showing sites of ablation The electroanatomical map showing the sites of ablation for the patient during pulmonary vein isolation. The red dots represent sites of ablation. The total procedure time was 2 hours and 9 minutes, and total left atrial ablation time was 18 minutes and 40 seconds.

Fig. 2

Computed tomography (CT) scan of the chest with oral and intravenous contrast showing contained esophageal perforation CT scan with contrast done 17 days after the ablation shows a mid esophageal perforation. There is extravasation of oral contrast media from the esophagus (blue arrow) into the mediastinal space in short distance to the left superior pulmonary vein. There is no visible connection to the left atrium or the pulmonary veins.

Fig. 3

Computed tomography (CT) scan of the chest with oral and intravenous contrast showing pneumomediastinum The same CT chest is shown. The mid esophageal perforation with extension into the mediastinal space results in a small amount of pneumomediastinum (blue arrows).