Atrioesophageal Fistula: A Review

Abstract

Catheter ablation of atrial ablation (AF) has become an important therapy in recent years. As with all evolving techniques, unexpected complication may occur. Atrioesophageal fistula is a very rare complication of AF catheter ablation. Described for the first time in two very experienced centers in 2004, this complication is the most dreadful and lethal among all the others related to AF catheter ablation. Its clinical presentation is extremely variable. Rapid diagnosis and surgical therapy may prevent death. This review article will summarize the risk factors, diagnosis, treatment and possible preventive strategies for this condition.

Keywords: Atrial Fibrillation; Catheter Ablation; Complications.

Figures

Figure 1.. Proximity of the LA and Esophagus. A) Fluoroscopy demonstrating an esophageal temperature probe (LET). As noted, the esophagus frequently lies immediately posterior to the LA. B) Intra-cardiac Echocardiography demonstrating the relationship between the LA and esophagus.

Figure 2.. Endoscopy demonstrating an esophageal ulcer, a possible precursor to AEF.

Figure 3.. Deviation of the esophagus. A) Fluoroscopy with barium contrast to highlight the baseline position of the esophagus posterior to the left atrium. Of note is the presence of a multi-electrode temperature monitor. B) Using a chest tube and stylet, the esophagus is deviated to the right and away from the left atrium and region where ablation is required. Barium highlights the course of the esophagus.

Figure 4.. Imaging to aid with the diagnosis of AEF. A) CT chest demonstrating air in the LA, B) MRI of the brain demonstrating infarctions in multiple territories, c) Echocardiogram demonstrating air in the left heart.

Figure 5.. Patient pocket card