Successful management of atrio-esophageal fistula using a fully covered esophageal stent case report

Abstract

Atrio-esophageal fistula (AEF) is a rare but fatal complication of cardiac ablation procedures.Approaches to management have focused on prompt diagnosis and surgical correction, as there is a high risk of patient decompensation and death from cerebrovascular morbidity and mortality. Esophageal stenting is not a standard approach and has been used exclusively for palliation in select cases with limited outcomes data. We report a case of a 61-year-old male presenting in critical condition due to AEF 4 weeks after cardiac ablation for persistent atrial fibrillation. The patient presented in septic shock, multisystem organ failure and was not a candidate for definitive surgical repair. Therefore, he underwent treatment with covered esophageal stent placement. The post-operative course was complicated by septic shock and cranial emboli. Despite the complex presentation and clinical progression, the patient made a meaningful neurologic and physiologic recovery. At 8 weeks he was discharged and at 10 weeks the stent was removed with demonstration of complete healing of the AEF. While surgical repair remains the standard of care for treatment of AEF as a result of cardiac ablation, in high-risk patients, esophageal stenting may provide a means for effective palliation. Stenting may allow for spontaneous healing of AEF in these select high-risk populations.