title: Clinical outcomes after repair of left atrial esophageal fistulas occurring after atrial fibrillation ablation procedures.
abstract: BACKGROUND
  The initial experience with left atrial esophageal fistula (LAEF) secondary to atrial fibrillation (AF) ablation procedures revealed a near-universal mortality. A comprehensive description of the principles of LAEF repair in the modern era and its resulting impact on morbidity and mortality are lacking in the literature.
  
  
  OBJECTIVE
  To describe the presentation, surgical management, and outcomes of patients with LAEF.
  
  
  METHODS
  A retrospective cohort analysis of 29 patients was performed, including previously unpublished cases of surgically repaired LAEF from 4 institutions (n = 6), and all published cases of surgically repaired (n = 16) or stented (n = 7) LAEF.
  
  
  RESULTS
  The mean age was 55 ± 13 years, and 75% were men who were undergoing radiofrequency energy catheter ablation (n = 26), cryoablation (n = 1), high-intensity focused ultrasound ablation (n = 1), and surgical mini-MAZE procedure (n = 1) and presented 30 ± 12 days postablation procedure. Overall, 55% of the patients receiving an intervention for LAEF died (41% surgical repair; 100% stent). Patients who did not receive primary esophageal repair were more likely to experience postoperative complications, including mediastinitis, need for percutaneous endoscopic gastrostomy (PEG) feeds, esophageal stent, or death (P = .05). In addition, interposing tissue between the repaired esophagus and the left atrium resulted in fewer postoperative complications (P = .02).
  
  
  CONCLUSIONS
  While improved relative to initial reports, mortality associated with LAEF remains high after corrective intervention. Primary esophageal repair with the placement of tissue between the repaired esophagus and the left atrium may result in lower morbidity and mortality.
authors: Division of Cardiology, Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: sheldon.singh@sunnybrook.ca.
authors: Sheldon M
authors: SM
authors: Singh
authors: Andre
authors: A
authors: d'Avila
authors: Steve K
authors: SK
authors: Singh
authors: Paul
authors: P
authors: Stelzer
authors: Eduardo B
authors: EB
authors: Saad
authors: Allan
authors: A
authors: Skanes
authors: Arash
authors: A
authors: Aryana
authors: Jason S
authors: JS
authors: Chinitz
authors: Robert
authors: R
authors: Kulina
authors: Marc A
authors: MA
authors: Miller
authors: Vivek Y
authors: VY
authors: Reddy
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation / Q000009:adverse effects*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005402:Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: AF; Adverse events; Atrial fibrillation; CPB; CT; Cardiothoracic surgery; Complication; EGD; Esophageal injury; Fistula; LA; LAEF; PEG; TEE; atrial fibrillation; cardiopulmonary bypass; computed tomography; esophagogastroduodenoscopy; left atrial esophageal fistula; left atrium/atrial; percutaneous endoscopic gastrostomy; transesophageal echocardiogram