Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting.

Journal Article

INTRODUCTION: Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies. METHODS: Nine patients with AEF post-RFCA for AF were included in this study. AEF was diagnosed based on symptoms and chest CT imaging. Of the 9 patients, 5 received stents and 4 underwent surgical repair of fistula. RESULTS: AF ablation was performed under general anesthesia (n = 4) or conscious sedation (n = 5). During ablation, RF power was maintained between 25 and 35 Watts in areas close to the esophagus and energy delivery discontinued when esophageal temperature reached 38 °C. Seven patients underwent ablation with 3.5-mm open-irrigated catheter, 1 with 8-mm nonirrigated catheter, and 1 had surgical epicardial ablation. Seven patients received proton pump inhibitor and sucralfate before and after procedure. AEF symptoms developed within 2–6 weeks from ablation. Esophageal stenting was performed in 5 patients (median age 58 years, median time from RFCA 4 weeks) and 4 underwent surgical repair (median age 54 years, median time from RFCA 4 weeks) within 2–4 hours from diagnosis. All 5 patients receiving stents died within 1 week of the procedure due to cerebral embolism, septic shock, or respiratory failure. On the other hand, the 4 patients that received surgical repair were alive at median follow-up of 2.1 years (P = 0.005). CONCLUSIONS: Esophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.

Full Text

Duke Authors

Cited Authors

  • Mohanty, S; Santangeli, P; Mohanty, P; Di Biase, L; Trivedi, C; Bai, R; Horton, R; Burkhardt, JD; Sanchez, JE; Zagrodzky, J; Bailey, S; Gallinghouse, JG; Hranitzky, PM; Sun, AY; Hongo, R; Beheiry, S; Natale, A

Published Date

  • June 2014

Published In

Volume / Issue

  • 25 / 6

Start / End Page

  • 579 - 584

PubMed ID

  • 25013875

Electronic International Standard Serial Number (EISSN)

  • 1540-8167

International Standard Serial Number (ISSN)

  • 1045-3873

Digital Object Identifier (DOI)

  • 10.1111/jce.12386

Language

  • eng