Atrioesophageal Fistula after Minimally Invasive Video-Assisted Epicardial Ablation for Lone Atrial Fibrillation.
Minimally invasive video-assisted epicardial beating heart ablation for lone atrial fibrillation claims to be safe and effective. We, however, report on three patients with an atrioesophageal fistula after this procedure. The exact pathogenesis of this complication is unknown. All patients presented around 6 weeks after surgery with either fever or neurological deficits. Diagnosis can be made by computed tomography scan. We advocate an aggressive surgical approach with closure of the atrial defect on cardiopulmonary bypass and closure and reinforcement of the esophagus with an intercostal muscle flap in a single-stage surgery. Some caution as to the low-risk character of this procedure seems to be realistic.
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
Charles
C
Kik
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
Richard
R
van Valen
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
Mostafa M
MM
Mokhles
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
Jos A
JA
Bekkers
Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
Ad J J C
AJJC
Bogers
D055011:Ablation Techniques / Q000009:adverse effects*; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed