Atrioesophageal Fistula Following Radiofrequency Catheter Ablation of Atrial Fibrillation

Orosey, Molly; Garg, Lohit; Agrawal, Sahil; John, Jinu; Haines, David E.; Wong, Wai Shun

doi:10.3909/ricm0883

Cited by 10 publications

(9 citation statements)

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“…Patients who survive surgical repair may suffer severe neurologic and cerebrovascular morbidity from air and septic emboli and embolic stroke. Hyperbaric oxygen therapy has been shown to improve neurologic deficits in patients with cerebral air emboli; however, it should not be used as definitive treatment in the place of surgical repair of the atrioesophageal fistula 13,16,18…”

Section: Discussionmentioning

confidence: 99%

“…3 Suggested measures during the RFCA procedure include limiting power to the posterior wall of the left atrium, employing esophageal temperature monitoring and esophageal cooling, visualization of the esophagus during RFCA, and mechanical displacement of the esophagus. 3,16,19 Di Biase and colleagues found that 48% of patients who underwent general anesthesia before RFCA developed an esophageal injury, compared with only 4% of patients who received moderate sedation and analgesia. 20 This is thought to be related to reduced peristalsis of the esophagus, lack of swallowing, and lack of pain reception during general anesthesia.…”

Section: Key Pointsmentioning

confidence: 99%

“…Summary of 45 case studies reporting atrioesophageal fistula following RFCA2,3,6,9,10,12,[14][15][16]18, …”

mentioning

confidence: 99%

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Atrioesophageal fistula

Jones¹,

Kara²

2022

Jaapa

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Atrioesophageal fi stula with resulting air emboli is a rare but potentially fatal complication of radiofrequency catheter ablation (RFCA) for atrial fi brillation. Patients typically present within 60 days after RFCA with fever, neurologic defi cits, chest pain, and gastrointestinal bleeding. Chest CT with IV contrast reveals the atrioesophageal fi stula in most cases, and CT of the head or MRI of the brain commonly reveals signs of air emboli. Early diagnosis, initiation of antibiotics, and immediate surgical intervention may improve patients' chances of survival.

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Section: Discussionmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

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Atrioesophageal fistula

Jones¹,

Kara²

2022

Jaapa

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“…Although poorly understood, proposed mechanisms of EAF formation include direct thermal injury during catheter ablations for atrial fibrillation, ischemia from thermal occlusion of surrounding vasculature after catheter ablations, infections, or caustic injury from gastric reflux exacerbation secondary to vagal nerve damage from iatrogenic interventions. 11,12 Diagnosis of EAF formation is most commonly evaluated through the use of CTwith IV contrast. 13 As the ulcerated esophagus extends toward the left atrium, CT imaging may reveal IV contrast within the esophageal lumen indicative of fistula tract formation.…”

Section: Esophagoatrial Fistulamentioning

confidence: 99%

“…Esohagoatrial fistulas (EAFs) can occur after injury to the thoracic esophagus as the esophagus travels posterior to the left atrium. Although poorly understood, proposed mechanisms of EAF formation include direct thermal injury during catheter ablations for atrial fibrillation, ischemia from thermal occlusion of surrounding vasculature after catheter ablations, infections, or caustic injury from gastric reflux exacerbation secondary to vagal nerve damage from iatrogenic interventions 11,12 …”

Section: Esophageal Fistula Forming Injuriesmentioning

confidence: 99%

Computed Tomography Imaging of Iatrogenic Esophageal Injuries

Sargent

Al‐Katib

2022

J Comput Assist Tomogr

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Knowledge of iatrogenic esophageal injuries is important given the variety of etiologies, including medical instrumentation (eg, endoscopes), radiotherapy, and anticoagulation. The clinical presentation and imaging findings of esophageal injuries depend on the mechanism and location of the injury. Imaging modalities commonly used for the evaluation of esophageal injuries include esophagram and computed tomography. Esophageal injuries should be considered in patients with acute chest symptoms. Recognizing an unsuspected esophageal injury on imaging can be critical to reaching the correct diagnosis given their nonspecific symptomatology. This review article highlights various iatrogenic esophageal injuries and their appearance on computed tomography imaging.

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Association of atrial fibrillation and gastroesophageal reflux disease: Natural and therapeutic linkage of the two common diseases

Maruyama

Fukata

Akashi

2018

Journal of Arrhythmia

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Atrial fibrillation (AF) is a common arrhythmia and gastroesophageal reflux disease (GERD) is popular in Japan. The two common diseases share several predisposing factors such as lifestyle and senescence, and inflammation and oxidative stress play an important role in their development and progression. Incidental cases of AF treated successfully by proton pump inhibitor (PPI) applied for coexisting GERD have been sporadically reported. An increasing evidence indicates that GERD induces the initiation and the perpetuation of AF. This is caused by the autonomic nerve influence, mechanical compression, and propagation of local inflammation due to proximity of left atrium (LA) and lower esophagus. Meanwhile, AF also develops GERD by mechanical and inflammatory actions of LA characterized by remodeling and inflammation. The robust association of AF with GERD is not limited to their natural interaction, i.e., pharmacological or nonpharmacological treatment of AF is reported to aggravate GERD. Many cardiac drugs (anticoagulants, calcium antagonists, and nitrates) induce esophageal mucosal damage and lower esophageal sphincter relaxation promoting acid reflux. These drugs are frequently prescribed in patients with AF for stroke prevention, rate control, and for coexisting coronary heart disease. Catheter ablation also yields both GERD and esophageal thermal injury, which is a precursor lesion of atrioesophageal fistula. The notion that AF and GERD are mutually interdependent is widely and empirically recognized. However, mechanistic link of the two common diseases and objective evaluation of PPI as an adjunctive AF treatment warrant future large‐scale prospective trials.

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Atrioesophageal Fistula Following Radiofrequency Catheter Ablation of Atrial Fibrillation

Cited by 10 publications

References 0 publications

Atrioesophageal fistula

Atrioesophageal fistula

Computed Tomography Imaging of Iatrogenic Esophageal Injuries

Association of atrial fibrillation and gastroesophageal reflux disease: Natural and therapeutic linkage of the two common diseases

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