Management of Atrio-esophageal Fistula Induced by Radiofrequency Catheter Ablation in Atrial Fibrillation Patients: a Case Series

Abstract

Atrio-esophageal fistula (AEF) is one of the most devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) and surgical repair is strongly recommended. However, optimal surgical approach remains to be elucidated. We retrospectively reviewed AEF cases that occurred after RFCA in a single center and evaluated the clinical results of different surgical approach. Surgical or endoscopic repair was attempted in five AF patients who underwent RFCA. Atrio-esophageal fistula and mediastinal infection was not controlled in the patient who underwent endoscopic repair eventually died. Lethal cerebral air embolism occurred two days after surgery in a patient who underwent esophageal repair only. Primary surgical repair of both the left atrium (LA) and esophagus was performed in the remaining three patients. Among these three patients, two underwent external LA repair and the remaining had internal LA repair via open-heart surgery. External repair of the LA was unsuccessful and one patient dies and another had to undergo second operation with internal repair of the LA. The patient who underwent internal LA repair during the first operation survived without additional surgery. Furthermore, we applied veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with artificial induction of ventricular fibrillation in this patient to prevent air and septic embolism and she had no neurologic sequelae. In summary, surgical correction can be considered preferentially to correct AEF. Open-heart surgical repair of LA from the internal side seems to be an acceptable surgical method. Application of VA-ECMO with artificial induction of ventricular fibrillation might be effective to prevent air and septic embolism.

Unusual esophageal injury after atrial fibrillation ablation: Early diagnosis and treatment to optimize outcomes

“…AF ablation provides improved rhythm control and quality of life compared to antiarrhythmic drugs, is associated with improved overall survival in patients with advanced heart failure, and is the standard of care for symptomatic AF refractory to antiarrhythmic drugs. 3 , 4 , 5 The number of AF ablation procedures is growing exponentially, as it is increasingly effective and safe. The mortality rate of AF ablation is at only 0.01%, with the cause of death most commonly related to cardiac tamponade, stroke, or AEF.…”

“…1 , 4 Serious complications after AF ablation include pericardial effusion and tamponade, hemothorax and pneumothorax, transient ischemic attack and stroke, pulmonary vein stenosis, and AEF. 4 , 5 …”

“…1 , 3 , 8 As esophageal injury progresses to AEF, recurrent strokes, sepsis, and gastrointestinal (GI) bleeding develop. 1 , 3 , 5 , 8 The late presentation, nonspecific symptoms, and failure to report a history of AF ablation frequently results in the misdiagnosis of esophageal injury and AEF.…”

Fibrilação Atrial (Parte 2) – Ablação por Cateter

“… 96 - 100 Felizmente, essa complicação tem incidência estimada ao redor de 0,04%, mas seu reconhecimento precoce pode ser fundamental para evitar um desfecho fatal. 99 , 101 - 103 …”

Slit-based irrigation catheters can reduce procedure-related ischemic stroke in atrial fibrillation patients undergoing radiofrequency catheter ablation

“…Claim data based retrospective data also suggest that RFCA is associated with reduced risk of ischemic stroke [4,5]. Despite various benefits of RFCA in AF patients, RFCA is associated with several catastrophic complications such as procedure-related stroke or atrio-esophageal fistula [6,7].…”