Atrial-oesophageal fistula following percutaneous radiofrequency catheter ablation of atrial fibrillation: the risk still persists.
Atrial-oesophageal fistula is a serious complication related to ablation of atrial fibrillation. As its occurrence is rare, there is a great lack of information about their mechanisms, incidence, presentations, and treatment. The objective of this manuscript is to present a series of cases of atrial-oesophageal fistula in Brazil, focusing on incidence, clinical presentation, and follow-up.



This is a retrospective multicentre registry of atrial-oesophageal fistula cases that occurred in eight Brazilian centres from 2003 to 2015. Ten cases (0.113%) of atrial-oesophageal fistula were reported in 8863 ablation procedures in the period. Most of the subjects were male (70%) with age 59.6 ± 9.3 years. Eight centres were reference units in atrial fibrillation ablation with an experience over than 200 procedures at the time of fistula occurrence. Oesophageal temperature monitoring was performed in eight cases using coated sensors in six. The first atrial-oesophageal fistula clinical manifestation was typically fever (in six patients), with a median onset time of 16.5 (12–43) days after ablation. There was a delay of 7.8 ± 3.3 days between the first manifestation and the diagnosis in five patients. The treatment was surgical in six cases, clinical in three and stenting in one. Seven patients died (70%) and two developed permanent neurological sequelae.



Atrial-oesophageal fistula remains a serious complication following AF ablation despite the incorporation of protective measures and increased technical experience of the groups. The high morbidity and mortality despite the treatment indicates the need to develop adequate preventive strategies.
Clinica de Ritmologia Cardiaca do Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil.
José Tarcisio
JT
Medeiros De Vasconcelos
Clinica de Ritmologia Cardiaca do Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil.
Silas Dos Santos Galvão
SDSG
Filho
Clínica São Vicente and Hospital Universitário da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Jacob
J
Atié
Clínica São Vicente and Hospital Universitário da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Washington
W
Maciel
Hospital Copa D'or - Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil.
Olga Ferreira
OF
De Souza
Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brazil.
Eduardo Benchimol
EB
Saad
Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Carlos Antonio
CA
Kalil
Hospital São Lucas e Hospital Primavera, Aracaju, SE, Brazil.
Rodrigo
R
De Castro Mendonça
Hospital da UNIMED - RJ, Rio de Janeiro, RJ, Brazil.
Nilson
N
Araujo
Instituto do Coração da Universidade de São Paulo, São Paulo, SP, Brazil.
Cristiano F
CF
Pisani
Instituto do Coração da Universidade de São Paulo, São Paulo, SP, Brazil.
Mauricio Ibrahim
MI
Scanavacca
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001938:Brazil / Q000453:epidemiology; D017115:Catheter Ablation / Q000009:adverse effects* / Q000401:mortality; D004937:Esophageal Fistula / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D005334:Fever / Q000453:epidemiology; D006325:Heart Atria / Q000293:injuries; D006335:Heart Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Atrial-oesophageal fistula; Atrial fibrillation; Radiofrequency catheter ablation