Pericardial–Esophageal Fistula: A Rare but Increasing Complication of Cardiac Ablation

Abstract

Pericardial–esophageal fistula and/or atrial–esophageal fistula after cardiac ablation is nearly universally fatal if not detected and treated expeditiously. This condition should be assumed and ruled out in anyone with a recent history of cardiac ablation presenting with signs of sepsis, pneumomediastinum, pneumopericardium, or chest pain. Computed tomography scan of the chest is a rapid and a sensitive diagnostic modality. Tenets of treatment and repair consist of preventing an air embolism, repairing the esophageal perforation and atrial defect, and interposing autologous tissue between the esophagus and heart.

Atrial-esophageal fistula after atrial fibrillation ablation: a case report and literature review

“…Gastroscopy could reveal esophageal damage, bleeding, or perforation. However, caution is recommended for the use of upper gastroscopy when AEF is highly suspected because the insufflation process of the esophagus may exacerbate the danger of air embolism ( 6 ). In this patient, we performed gastroscopy for the identification of AEF and formulated the following surgical proposal.…”

Esophagopericardial fistula complicated by tension pyopericardium managed with a 3-incision esophagectomy

“…Esophageal stenting, especially in a contaminated field, has a high failure rate and rather is used as a bridge for operative intervention. E1 , E5 In our opinion, stenting should not be used as definitive management for cases involving esophageal fistulae and should only be reserved for patients unfit for immediate surgery or for palliative purposes.…”

“…Most reports in the literature regarding esophagopericardial fistulization are within the setting of cardiac ablation procedures E1 or esophageal carcinomas, 3 , 4 with management including primary repair or, in severe cases, esophagectomy. E1 Esophagopericardial fistula secondary to endoscopic interventions are extremely rare. 1 , 2 …”

“…In most cases this can be achieved via right thoracotomy, although a median sternotomy approach has been described. E1 In cases of primary repair, the best practice is to interpose vascularized tissue between the esophagus and the pericardium. Flap options include an intercostal muscle flap, pericardial fat pad, pleural flap, and less commonly diaphragm or omental flaps.…”

Subxiphoid pericardial drainage for gastric tube ulcer penetrating the pericardium after esophagectomy: A case report

“…Reconstructed gastric tube ulcers have few subjective symptoms because of the sympathetic nerve transection during creation of the gastric tube [ 5 ]; however, they are often only discovered in severe cases. When a gastric tube ulcer penetrates the pericardium, most patients present with symptoms such as fever, chest pain, respiratory distress, and hematemesis [ [5] , [6] , [7] , [8] ].…”