title: Atrioesophageal fistula in the era of atrial fibrillation ablation: a review.
abstract: The purpose of this review is to understand the epidemiology, clinical features, etiopathogenesis, and management of atrioesophageal fistula (AEF) after atrial fibrillation (AF) ablation. The incidence of AEF after AF ablation is 0.015%-0.04%. The principal clinical features include fever, dysphagia, upper gastrointestinal bleeding, sepsis, and embolic strokes. The close proximity of the esophagus to the posterior left atrial wall is responsible for esophageal injury during ablation. Prophylactic proton pump inhibitors, esophageal temperature monitoring, visualization of the esophagus during catheter ablation, esophageal protection devices, and avoidance of energy delivery in close proximity to the esophagus play an important role in preventing esophageal injury. Early surgical repair or esophageal stenting are the mainstay of treatment. Eliminating esophageal injury during AF ablation is of utmost importance in preventing AEF. A high index of suspicion and early intervention is necessary to prevent fatal outcomes.
authors.affiliation: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: gnair@ottawaheart.ca.
authors.forename: Girish M
authors.initials: GM
authors.lastname: Nair
authors.affiliation: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Pablo B
authors.initials: PB
authors.lastname: Nery
authors.affiliation: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Calum J
authors.initials: CJ
authors.lastname: Redpath
authors.affiliation: Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Buu-Khanh
authors.initials: BK
authors.lastname: Lam
authors.affiliation: Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: David H
authors.initials: DH
authors.lastname: Birnie
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D001831:Body Temperature; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D003680:Deglutition Disorders / Q000209:etiology; D003952:Diagnostic Imaging; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005402:Fistula / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007964:Leukocytosis / Q000209:etiology; D016343:Monitoring, Intraoperative; D009092:Mucous Membrane / Q000293:injuries; D011300:Preoperative Care