Atrioesophageal Fistula after Minimally Invasive Video-Assisted Epicardial Ablation for Lone Atrial Fibrillation

Abstract

Minimally invasive video-assisted epicardial beating heart ablation for lone atrial fibrillation claims to be safe and effective. We, however, report on three patients with an atrioesophageal fistula after this procedure. The exact pathogenesis of this complication is unknown. All patients presented around 6 weeks after surgery with either fever or neurological deficits. Diagnosis can be made by computed tomography scan. We advocate an aggressive surgical approach with closure of the atrial defect on cardiopulmonary bypass and closure and reinforcement of the esophagus with an intercostal muscle flap in a single-stage surgery. Some caution as to the low-risk character of this procedure seems to be realistic.

Atrial-Esophageal Fistula after Thoracoscopic Maze Surgery: The Real Perspective

“…We would like to comment on the devastating complication following endoscopic ablation reported by Kik et al 1 In their conclusion, they challenge the "low-risk character" of this procedure. While the occurrence of such a complication in 3 out of 21 patients might have contributed to their messaging, we believe this has not been brought to the right perspective throughout their communication.…”

Reply by the Authors of the Original Article

“…In our short communication, we describe three cases. 1 The last case was from another hospital. The reason for referral to our hospital was our unfortunate "expertise" with this complication.…”