title: Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting.
abstract: BACKGROUND
  Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies.
  
  
  METHODS
  Nine patients with AEF post-RFCA for AF were included in this study. AEF was diagnosed based on symptoms and chest CT imaging. Of the 9 patients, 5 received stents and 4 underwent surgical repair of fistula.
  
  
  RESULTS
  AF ablation was performed under general anesthesia (n = 4) or conscious sedation (n = 5). During ablation, RF power was maintained between 25 and 35 Watts in areas close to the esophagus and energy delivery discontinued when esophageal temperature reached 38 °C. Seven patients underwent ablation with 3.5-mm open-irrigated catheter, 1 with 8-mm nonirrigated catheter, and 1 had surgical epicardial ablation. Seven patients received proton pump inhibitor and sucralfate before and after procedure. AEF symptoms developed within 2–6 weeks from ablation. Esophageal stenting was performed in 5 patients (median age 58 years, median time from RFCA 4 weeks) and 4 underwent surgical repair (median age 54 years, median time from RFCA 4 weeks) within 2–4 hours from diagnosis. All 5 patients receiving stents died within 1 week of the procedure due to cerebral embolism, septic shock, or respiratory failure. On the other hand, the 4 patients that received surgical repair were alive at median follow-up of 2.1 years (P = 0.005).
  
  
  CONCLUSIONS
  Esophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Chintan
authors.initials: C
authors.lastname: Trivedi
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.forename: Jason
authors.initials: J
authors.lastname: Zagrodzky
authors.forename: Shane
authors.initials: S
authors.lastname: Bailey
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Gallinghouse
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Hranitzky
authors.forename: Albert Y
authors.initials: AY
authors.lastname: Sun
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D015331:Cohort Studies; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006325:Heart Atria / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D015607:Stents; D016896:Treatment Outcome