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Case Reports
. 2022 Sep 21;4(18):1180-1185.
doi: 10.1016/j.jaccas.2022.04.027.

Esophago-Pericardial Fistula as a Rare and Life-Threatening Complication of Epicardial Ventricular Tachycardia Ablation

Justin A Edward  1 , Shu C Chang  2 , Edward A Gill  1 , Wendy S Tzou  2 , Ryan G Aleong  2
Affiliations
Case Reports

Esophago-Pericardial Fistula as a Rare and Life-Threatening Complication of Epicardial Ventricular Tachycardia Ablation

Justin A Edward et al. JACC Case Rep. .

Abstract

We describe a rare complication of esophago-pericardial fistula after epicardial ventricular tachycardia ablation. Echocardiogram revealed evidence of pneumopericardium and additional imaging studies confirmed esophageal leak with evidence of fistula formation requiring prompt surgical repair. (Level of Difficulty: Intermediate.).

Keywords: AF, atrial fibrillation; CT, computed tomography; VT, ventricular tachycardia; ablation; complication; electrophysiology; ventricular tachycardia.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Electrocardiograms During Initial Presentation (A) Electrocardiogram of the patient with ventricular tachycardia experienced on day of admission. (B) After conversion to sinus rhythm, diffuse ST-segment elevations are noted consistent with pericarditis.
Figure 2
Figure 2
Intraprocedural Fluoroscopy Images and 3-Dimensional Electroanatomic Map (A) Right anterior oblique (RAO) view of the catheter and probe positions. The multipolar catheter was positioned in the inferior base of the epicardial space. An esophageal temperature probe is also within view distally in the esophagus. (B) Left anterior oblique (LAO) view of the same catheter positions. The multipolar catheter can be seen adjacent to the esophagus as outlined by the esophageal temperature probe. (C) Electroanatomic map of the left ventricular epicardium with the large cluster ablation lesions in the inferior base of the left ventricular epicardium denoted by red circles.
Figure 3
Figure 3
Transthoracic Echocardiographic Still and Sagittal Computed Tomography Chest Image (A) A subcostal transthoracic echocardiographic image showing the presence of a pneumopericardium. (B) A sagittal computed tomography chest image also detailing pneumopericardium. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
Figure 4
Figure 4
Barium Esophagram and Surgical Repair (A) Oral contrast is ingested and outlines the esophagus. (B) An esophago-pericardial fistula is noted as the contrast migrates past the esophagus. (C) Surgical repair of the esophageal and pericardial defects undertaken through a left thoracotomy approach.
See this image and copyright information in PMC

References

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