title: Successful non-operative management of left atrioesophageal fistula following catheter ablation.
abstract: Atrioesophageal fistula (AEF) is a potentially lethal complication of catheter radiofrequency ablation for atrial fibrillation. A 49-year-old man with paroxysmal atrial fibrillation who underwent catheter ablation around the pulmonary vein was admitted 31 days after the procedure, suffering seizures and fever. Magnetic resonance imaging of the brain showed ischemia and multiple lesions of acute infarction in the right occipital lobe of the cerebrum. Computed tomography (CT) of the chest showed a small accumulation of air between the posterior left atrium and the esophagus, suggesting an AEF. Endoscopic snaring of the esophageal mucosa, repeated a few times, supported by nil by mouth and antibiotic therapy, resulted in improvement of his condition with no recurrence of symptoms. Subsequent chest CT scans confirmed disappearance of the leaked air and the patient was discharged home 45 days after admission with no neurological compromise.
authors.affiliation: Division of Cardiovascular Surgery, Saitama Red-cross Hospital, 8-3-33 Kamiochiai, Chyuo-ku, Saitama, Saitama, 338-8553, Japan, manabu@omiya.jichi.ac.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Shiraishi
authors.forename: Hideki
authors.initials: H
authors.lastname: Morita
authors.forename: Kenichi
authors.initials: K
authors.lastname: Muramatsu
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Junichi
authors.initials: J
authors.lastname: Nitta
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
mesh_terms: D000208:Acute Disease; D001281:Atrial Fibrillation / Q000601:surgery*; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D004945:Esophagoscopy; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009778:Occipital Lobe; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D011667:Pulmonary Veins; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome