title: Successful nonsurgical treatment of esophagopericardial fistulas after atrial fibrillation catheter ablation: a case series.
abstract: BACKGROUND
  Esophageal perforations are a rare but devastating complication of atrial fibrillation catheter ablation. Rapid treatment is crucial to avoid permanent disabilities and death. Surgical treatment is considered the treatment of choice. Alternatively, single case reports describe successful esophageal stenting, but others discourage this approach because of fatal consequences.
  
  
  RESULTS
  We present 3 patients who developed esophagopericardial fistulas after radiofrequency catheter ablation of atrial fibrillation. Diagnosis and management with pericardial drainage and esophageal stenting, as well as long-term follow-up are described. Esophagopericardial fistulas occurred 26, 9, and 18 days after the ablation procedure. Symptoms leading to admission were recurrence of atrial fibrillation (n=1), elective control endoscopy for thermal lesion (n=1), and pain with swallowing (n=1). Computed tomography revealed esophagopericardial fistulas with pericardial effusion in all patients, while contrast leakage and air in the left atrium could be excluded. Broad-spectrum antibiotics were initialized, and minimally invasive pericardial drainage and esophageal stenting were performed. Stent dislocation occurred in 2 patients and was resolved by repositioning and clipping of the proximal stent end. After 45, 22, and 28 days, respectively, fistulas appeared closed and stents were removed. During follow-up, no embolic or septic events occurred. However, 2 patients underwent dilation of symptomatic esophageal stenosis in the formerly stented region.
  
  
  CONCLUSIONS
  An early minimally invasive approach consisting of pericardial drainage and esophageal stenting proved effective in treating patients with esophagopericardial fistulas. However, constant interdisciplinary communication and attention is needed to recognize and manage potential evolving complications promptly.
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.forename: Markus
authors.initials: M
authors.lastname: Zachäus
authors.forename: Silke
authors.initials: S
authors.lastname: John
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Ulrich
authors.initials: U
authors.lastname: Halm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D003131:Combined Modality Therapy; D004322:Drainage; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy / Q000295:instrumentation; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology / Q000628:therapy; D010496:Pericardium / Q000293:injuries*; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: adverse events complication; atrial fibrillation; catheter ablation; esophageal perforation; fistula; pericardial effusion; stenting