[Neurological complications of atrioesophageal fistulas: postprandial insults, epilepsy and meningitis].
BACKGROUND
Atrioesophageal fistulas (AEF) are a life-threatening complication of left atrial ablation for atrial fibrillation or other atrial rhythm disorders, which mostly manifest as neurological deficits. AEFs result in an overflow of esophageal contents into the left atrium with subsequent systemic embolization.


RESULTS
AEFs have been reported in 40 patients, including 18 males, between 35 and 72 years of age. AEFs manifested clinically between 3 and 36 days following the ablation. The most common neurological manifestations are postprandial embolic stroke followed by epileptic seizures and meningitis. More rarely, disorders of consciousness without epilepsy or stroke, psychiatric abnormalities or cerebral air embolisms have been observed. The diagnosis is made upon thoracic computed tomography with contrast medium. Deglutation radiography, transesophageal echocardiography, gastroscopy and esophageal stenting must be absolutely avoided. The only expedient therapy is surgical cleansing of the fistula but even then the prognosis is very poor with a mortality of 63%.


CONCLUSIONS
An AEF should always be considered in patients with fever, difficulties in swallowing, thoracic pain, postprandial transient ischemic attacks (TIA) or stroke, epileptic seizures, or meningitis. In the case of AEFs an ablation of atrial fibrillation in the patient history should be considered and corresponding diagnostics and treatment should be initiated immediately.
Krankenanstalt Rudolfstiftung, Wien, Österreich. fifigs1@yahoo.de
J
J
Finsterer
C
C
Stöllberger
T
T
Pulgram
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D004827:Epilepsy / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D004937:Esophageal Fistula / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D008581:Meningitis / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D019518:Postprandial Period
Circulation. 2004 Jun 8;109(22):2724-6
15159294
J Interv Card Electrophysiol. 2009 Jan;24(1):33-6
18836822
Ann Thorac Surg. 2003 Jul;76(1):281-3
12842562
Emerg Med Australas. 2009 Aug;21(4):329-32
19682020
Am Heart J. 2009 Jul;158(1):15-20
19540387
J Cardiovasc Electrophysiol. 2010 Jun 1;21(6):708-11
20102433
J Thorac Imaging. 2007 Aug;22(3):283-5
17721345
J Thorac Cardiovasc Surg. 2010 Feb;139(2):507-9
19660291
J Cardiovasc Electrophysiol. 2004 Aug;15(8):960-2
15333097
J Thorac Cardiovasc Surg. 2003 Apr;125(4):836-42
12698146
J Thorac Cardiovasc Surg. 2001 Dec;122(6):1239-40
11726904
Europace. 2006 Mar;8(3):189-90
16627437
J Thorac Imaging. 2007 May;22(2):188-91
17527128
J Cardiovasc Electrophysiol. 2009 Sep;20(9):1014-9
19490383
Ann Fr Anesth Reanim. 2008 Jun;27(6):499-501
18472388
J Am Coll Cardiol. 2009 May 12;53(19):1798-803
19422987
Ann Intern Med. 2006 Apr 18;144(8):572-4
16618954
J Cardiovasc Electrophysiol. 2006 Nov;17(11):1213-5
16987382
Heart Rhythm. 2008 Jan;5(1):145-8
18053769