Massive air embolism caused by an atrioesophageal fistula following isolation of the pulmonary veins for atrial fibrillation

Traykov, Vassil; Kirova, Galina; Karagyozov, Petko; Marchov, D; Kaninski, Genadi; Гелев, Валери

doi:10.1016/j.hrcr.2018.11.003

Cited by 3 publications

(11 citation statements)

References 13 publications

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“…Although no preventive measures for developing an atrioesophageal fistula have been extensively studied, many recommendations are outlined in the literature 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.…”

Section: Discussionmentioning

confidence: 99%

“…Symptom management and rate and rhythm control of AF often are managed with medications 1. RFCA is a common treatment for drug-refractory symptomatic AF, with more than 50,000 procedures performed in the United States annually 2,3. Although RFCA may improve quality of life and better maintain sinus rhythm than antiarrhythmic drugs, late recurrences of AF are common 1.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 99%

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Atrioesophageal fistula

Jones¹,

Kara²

2022

Jaapa

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“…www.nature.com/scientificreports www.nature.com/scientificreports/ Surgical approach. We consider that aggressive and timely surgery is the cornerstone of the AEF management [16][17][18][19] . We had four surgical cases where surgeons confirmed that there was a significant area of thermal injury in both LA and esophagus adjacent to the fistula location.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral air or septic embolism are major adverse events in patients suffering AEF 16,20,21 . Substantial proportions of embolic events occur in acute phase of AEF and neurologic symptoms related with cerebral embolism are often the presenting symptoms.…”

Section: Prevention Of Embolismmentioning

confidence: 99%

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

Shim

Lee

Lim

et al. 2020

Sci Rep

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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.

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