Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports

Patricia Chavez, Franz H Messerli, Abel Casso Dominguez, Emad F Aziz, Tina Sichrovsky, Daniel Garcia, Connor D Barrett, Stephan Danik, Patricia Chavez, Franz H Messerli, Abel Casso Dominguez, Emad F Aziz, Tina Sichrovsky, Daniel Garcia, Connor D Barrett, Stephan Danik

Abstract

Background: Atrioesophageal fistula (AEF) is a rare but serious adverse event of atrial fibrillation (AF) ablation.

Objective: To identify the clinical characteristics of AEF following ablation procedures for AF and determine the associated mortality.

Methods: A systematic review of observational cases of AEF following ablation procedures for AF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol.

Results: 53 cases were identified. Mean age was 54±13 years; 73% (39/53) of cases occurred in males. Mean interval between procedure and presentation was 20±12 days, ranging from 2 to 60 days. AEF was observed in 12 patients who underwent surgical radiofrequency ablation (RFA) and in 41 patients with percutaneous RFA. Fever was the most common presenting symptom (n=44) followed by neurological deficits (n=27) and haematemesis (n=19). CT of the chest (n=27) was the preferred diagnostic test. Patients who did not receive a primary esophageal repair were more likely to have a deadly outcome (34% vs 83%; p<0.05). No difference in mortality rate was found between patients who underwent surgical RFA when compared with percutaneous RFA (58% vs 56%; p=0.579). No association was found between onset of symptoms and mortality (19±10 vs 23±14 days; p=0.355).

Conclusions: AEF following ablation procedures for AF is a serious complication with high mortality rates. Presenting symptoms most often include a triad of fever, neurological deficit and/or haematemesis within 60 days of procedure. The preferred diagnostic test is CT of the chest. The treatments of choice is surgical repair.

Keywords: CARDIAC SURGERY.

Figures

Figure 1
Figure 1
Frequency of symptoms at time of presentation. Neurological deficits include motor and language impairment; altered mental status was also described as confusion.
Figure 2
Figure 2
Diagnostic modalities on presentation to the emergency room (CT abd/pelvis, CT of the abdomen and pelvis with contrast; CT chest, CT of the chest with intravenous contrast; CT head, CT of the head without contrast; CCTA, computed cardiac tomographic angiograph; .MRI brain, MRI of the brain; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography).

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