Incidence, epidemiology, diagnosis and prognosis of atrio-oesophageal fistula following percutaneous catheter ablation: a French nationwide survey

Abstract

Aims Rate, incidence, risk factors, and optimal management of atrio-oesophageal fistula (AOF) after catheter ablation for atrial fibrillation (AF) remain obscure. Methods and results All French centres performing AF ablation were identified and surveys were sent concerning the number of procedures, eventual cases of AOF, and characteristics of such cases. Eighty-two of the 103 centres (80%) performing AF ablation in France were included, with a total of 129 286 AF ablations since 2006 (93% of the whole procedures in France). Thirty-three AOF were reported (reported rate 0.026% per procedure) with a stable reported annual incidence despite the increasing number of procedures. Sensitivity of computed tomography (CT) scan for AOF was 81%. Mortality was 60%, significantly lower in case of surgical corrective therapy (31 vs. 93%, P = 0.001). Conclusion The reported rate of AOF after AF ablation in this nationwide survey was 0.026%, with a stable reported annual incidence over time. A normal CT scan does not rule out the diagnosis and should be repeated in case of suspicion. Prognosis remains poor with a mortality of 60% and crucially dependant of immediate surgical correction. No clear protective strategy has been proven effective.

Virtual Reality for Sedation During Atrial Fibrillation Ablation in Clinical Practice: Observational Study

“…Atrial fibrillation (AF) ablation is an established therapy for patients with symptomatic AF [ 1 ]. The number of AF ablations is increasing year on year, but the availability of general anesthesia does not meet demand [ 2 ]. As such, it is now commonplace for procedures to be performed under conscious sedation.…”

Esophagopericardial Fistula

“…The most severe esophageal perforating complication is esophagoatrial fistula (AEF) (stressing the course of esophagus-to-atrium progression), with a fatality rate of 60% to 80%. In AEF, early surgical intervention appears to be the only beneficial treatment option ( 2 , 3 , 4 , 5 ). Incidences of AEF have been stable over the past years, and although published survey-reported incidences have been approximately 0.02%, clinically detected incidences appear to be relevantly higher in more rigid follow-up studies ( 2 , 3 , 4 , 5 ), as well as potentially in real life.…”

“…In AEF, early surgical intervention appears to be the only beneficial treatment option ( 2 , 3 , 4 , 5 ). Incidences of AEF have been stable over the past years, and although published survey-reported incidences have been approximately 0.02%, clinically detected incidences appear to be relevantly higher in more rigid follow-up studies ( 2 , 3 , 4 , 5 ), as well as potentially in real life. AEF may be the only AF ablation complication not related to operator or center experience, and therefore a high degree of suspicion is warranted in any AF ablation program.…”

“…AEF may be the only AF ablation complication not related to operator or center experience, and therefore a high degree of suspicion is warranted in any AF ablation program. Procedural denominators have not been identified, but it has become clear that esophageal protection devices such as temperature monitors have not been able to eliminate AEF ( 2 , 3 , 4 , 5 ).…”

“…This condition is defined by normal esophageal endoscopic findings after the ablation with the occurrence of esophageal ulcerating injury days later. The mechanism of progression appears to be related to reflux of gastric acid, potentially facilitated by damage to periesophageal nerves and esophageal motility (including sphincter plegia), ischemia, and delay of the healing process secondary to transmural damage of the vasculature and potentially also from decreased pain sensation and inflammation ( 1 , 2 , 3 , 4 , 5 ).…”