Atrioesophageal Fistula in the Era of Atrial Fibrillation Ablation: A Review

Nair, Girish M.; Nery, Pablo B.; Redpath, Calum J.; Lam, Buu-Khanh; Birnie, David H.

doi:10.1016/j.cjca.2013.12.012

Cited by 83 publications

(109 citation statements)

References 53 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…Atrioesophageal fistula is a rare but catastrophic complication of catheter ablation of AF and its incidence is estimated at 0.04% [123]. Esophagus is located behind the LA and it is in close anatomic relationship with its posterior wall, and contact area could be even larger in patients with LA dilatation, esophageal diverticulosis and thinner adipose-fibrous layer between the LA and esophagus [176]. Thermal injury of esophageal wall and impairment of small blood vessels cause ischemic necrosis of its mucosa and lead to local inflammation and ulceration formation, which are prerequisites for occurrence of atrioesophageal fistula [176].…”

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

“…Esophagus is located behind the LA and it is in close anatomic relationship with its posterior wall, and contact area could be even larger in patients with LA dilatation, esophageal diverticulosis and thinner adipose-fibrous layer between the LA and esophagus [176]. Thermal injury of esophageal wall and impairment of small blood vessels cause ischemic necrosis of its mucosa and lead to local inflammation and ulceration formation, which are prerequisites for occurrence of atrioesophageal fistula [176]. One study shows that incidence of esophageal mucosal injury after the catheter ablation of AF was 17% [177].…”

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

“…Capsule endoscopy procedure is feasible and safe and the method of choice is contrast enhanced thoracic CT [176,177]. Many different procedures aiming to prevent esophageal injury were presented during the last few years.…”

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

“…During the procedure, direct and real-time visualization of esophagus enables operator to modify ablation trajectory in the LA and to move away from esophagus. It could be accomplished with simple esophageal opacification by ingestion of barium paste, using of ICE and creating 3D geometrical map of esophagus and LA with integration of CT/MRI scan by means of electroanatomical mapping system [3,120,176,177].…”

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

See 3 more Smart Citations

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

View full text Add to dashboard Cite

Atrial fibrillation is the most common sustained arrhythmia in clinical practice, associated with increased mortality, risk of stroke and heart failure, as well as the reduction of the quality of life. Atrial fibrillation may be encountered in young otherwise healthy individuals, due to the isolated electrophysiological disorder limited mostly to the pulmonary veins and posterior left atrial wall, or associated with the presence of advanced underlying heart disease and numerous cardiac and non-cardiac comorbidities with significant structural remodeling of the atrial myocardium. Due to limited efficacy and serious side effects of antiarrhythmic drugs, catheter ablation of atrial fibrillation, based on the pulmonary vein isolation for paroxysmal atrial fibrillation and adjunctive substrate modification for persistent atrial fibrillation, has emerged as an attractive and promissing alternative therapeutic option for selected patients with atrial fibrillation. In this review article, we discuss the electrophysiological left atrial abnormalities underlying lone atrial fibrillation and the role of pulmonary veins in pathophysiology of arrhythmia, and we summarize results of the studies on the long term outcome of catheter ablation of atrial fibrillation, as well as the studies on comparison of antiarrhythmic drugs with catheter ablation for treatment of atrial fibrillation. In addition, we present available data that provide better understanding of mechanisms, diagnosis, prevention and treatment of specific procedure-related complications and discuss current periprocedural anticoagulation strategies and their impact on the thromboembolic risk reduction.

show abstract

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

See 2 more Smart Citations

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

View full text Add to dashboard Cite

show abstract

“…The patient's condition deteriorated and he consequently died. Atrio-esophageal fistula is a rare but serious complication of atrial fibrillation ablation [1,2]. Patients are at risk of air embolism and mediastinitis.…”

mentioning

confidence: 99%

Endoscopy-guided surgery of an atrio-esophageal fistula after failure of self-expandable metal stents

et al. 2017

View full text Add to dashboard Cite

Endoscopy-guided surgery of an atrio-esophageal fistula after failure of self-expandable metal stents A 34-year-old man presented at the emergency department with syncope and atrial fibrillation. He had undergone atrial fibrillation ablation 3 weeks earlier.He was initially treated with anti-arrhythmic agents but developed seizures. A computed tomography scan revealed air embolisms on the brain and an atrioesophageal fistula in the mediastinum (▶ Fig. 1). Because of hemodynamic instability, surgeons asked the Gastroenterology Department to place an esophageal stent. A pediatric gastroscope was used to pass the guidewire. A completely covered selfexpandable metal stent (Boston Scientific, Marlborough, Massachusetts, USA) was placed using only radiological guidance. The insufflation bottle was disconnected to avoid unnoticed insufflation. Two days later a coaxial stent was placed because the first stent had migrated proximally (▶ Fig. 2). Seven days later, after initial improvement, the second stent also migrated proximally. The patient's condition continued to worsen, so it was decided to close the fistula surgically. Surgery was performed with extracorporeal circulation. Cardiovascular surgeons repaired the defect in the atrium (▶ Fig. 3 a) with endoscopic guidance from the esophagus (▶ Fig. 3 b). Endoscopy discovered another previously undetected fistula. A new completely covered metal stent was placed to protect the esophagus at the end of the procedure (▶ Video 1). The following day, the patient developed cardiac and renal failure. The patient's condition deteriorated and he consequently died. Atrio-esophageal fistula is a rare but serious complication of atrial fibrillation ablation [1,2]. Patients are at risk of air embolism and mediastinitis. For this reason, endoscopy is contraindicated and urgent surgery is preferred as treatment. Endoscopy can be helpful to guide treatment during surgery, and in this case, a hidden fistula was discovered. Previous cases describing endoscopic treatment with stents with fatal result have been reported [3,4]. Successful treatment of other complications of atrial fibrillation ablation, such as esophageal perforation or esophago-pericardial fistula with stents, has been described. Endoscopy_UCTN_Code_CCL_1AB_2AC_3AHCompeting interests None Video 1 Computed tomography revealed air in the mediastinum after atrial fibrillation ablation. After migration of two metal stents, it was decided to operate on the patient with endoscopic guidance.▶ Fig. 1 Computed tomography showing air in the mediastinum caused by an atrio-esophageal fistula. E-Videos E250Couto-Worner Ignacio et al. Endoscopy-guided surgery of atriosophageal fistula … Endoscopy 2017; 49: E250-E251

show abstract