title: Temporary esophageal stenting allows healing of esophageal perforations following atrial fibrillation ablation procedures.
abstract: BACKGROUND
  Left atrial catheter ablation (LACA) has emerged as a successful method to eliminate atrial fibrillation (AF). Recent reports have described atrio-esophageal fistulas, often resulting in death, from this procedure. Temporary esophageal stenting is an established therapy for malignant esophageal disease. We describe the first case of successful temporary esophageal stenting for an esophageal perforation following LACA.
  
  
  METHODS
  A 48-year-old man with symptomatic drug refractory lone AF underwent an uneventful LACA. Fifty-nine ablations with an 8-mm tip ablation catheter (30 seconds, 70 Watts, 55 degrees C), as guided by 3-D NavX mapping, were performed in the left atrium to isolate the pulmonary veins as well as a left atrial flutter and roof ablation line. In addition, complex atrial electrograms in AF and sites of vagal innervation were ablated. Two weeks later, he presented with sub-sternal chest pain, fever, and dysphagia. A chest CT showed a 3-mm esophageal perforation at the level of the left atrium with mediastinal soiling and no pericardial effusion. An urgent upper endoscopy with placement of a PolyFlex removable esophageal stent to seal off the esophago-mediastinal fistula was performed. After 3 weeks of i.v. antibiotics, naso-jejunal tube feedings, and esophageal stenting, the perforation resolved and the stent was removed. Over 18 months of follow-up, there have been no other complications, and he has returned to a physically active life and remains free from AF on previously ineffective anti-arrhythmic drugs.
  
  
  CONCLUSIONS
  Early diagnosis of esophageal perforations following LACA may allow temporary esophageal stenting with successful esophageal healing. Prompt chest CT scans with oral and i.v. contrast should be considered in any patient with sub-sternal chest pain or dysphagia following LACA.
authors.affiliation: Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nelson
authors.forename: Tom
authors.initials: T
authors.lastname: Foley
authors.forename: Scott
authors.initials: S
authors.lastname: Allison
authors.forename: Brian G
authors.initials: BG
authors.lastname: Crandall
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Osborn
authors.forename: J Peter
authors.initials: JP
authors.lastname: Weiss
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.forename: Peter
authors.initials: P
authors.lastname: Nielsen
authors.forename: Lars
authors.initials: L
authors.lastname: Anderson
authors.forename: Donald L
authors.initials: DL
authors.lastname: Lappe
authors.forename: John D
authors.initials: JD
authors.lastname: Day
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000293:injuries* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D012421:Rupture; D015607:Stents; D014057:Tomography, X-Ray Computed