Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation.
BACKGROUND
Radiofrequency ablation for atrial fibrillation is becoming widely practiced.


RESULTS
Two patients undergoing circumferential pulmonary vein ablation for atrial fibrillation in different centers developed symptoms compatible with endocarditis 3 to 5 days after the procedure. Their clinical condition deteriorated rapidly, and both suffered multiple gaseous and/or septic embolic events causing cerebral and myocardial damage. One patient survived after emergency cardiac and esophageal surgery; the other died of extensive systemic embolization. An atrio-esophageal fistula was identified in both patients.


CONCLUSIONS
Atrio-esophageal fistulas can occur after catheter ablation in the posterior wall of the left atrium. This diagnosis should be excluded in any patient with symptoms or signs of endocarditis after left atrial ablation, and expeditious cardiac surgery is critical if the diagnosis is confirmed. Lower power and temperature settings for applications of radiofrequency energy along the posterior left atrial wall may prevent further cases of fistula formation.
Pappone
Carlo
C
Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. carlo.pappone@hsr.it
Oral
Hakan
H
Santinelli
Vincenzo
V
Vicedomini
Gabriele
G
Lang
Christopher C
CC
Manguso
Francesco
F
Torracca
Lucia
L
Benussi
Stefano
S
Alfieri
Ottavio
O
Hong
Robert
R
Lau
William
W
Hirata
Kirk
K
Shikuma
Neil
N
Hall
Burr
B
Morady
Fred
F
D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology*; D005402:Fistula / Q000175:diagnosis / Q000209:etiology*; D006325:Heart Atria / Q000293:injuries*; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged