Atrio-esophageal fistula

A case series and literature review

Craig A. Schuring, Luke J. Mountjoy, Ashley B. Priaulx, Robert J. Schneider, Hayden L. Smith, Geoffrey C. Wall, Dipen Kadaria, Amik Sodhi

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Objective: Rare disease Background: Percutaneous catheter radiofrequency ablation (RFA) and cryoablation of the left atrium and pulmonary vein ostia have become successful therapeutic modalities in the management of atrial fibrillation. Atrio-esophageal fistula is a rare complication. Awareness of complication risk is imperative because without prompt diagnosis and urgent surgical intervention, the outcome is often fatal. We present 3 cases of atrio-esophageal fistula following percutaneous catheter radiofrequency ablation (RFA). Case Reports: Case 1: A 72-year old white male presented 27 days after percutaneous RFA for atrial fibrillation with fever, altered mental status, and melena. Esophagogastroduodenoscopy (EGD) revealed a 1-cm defect in the mid-esophagus. Upon thoracotomy, severe hemorrhage ensued from a concomitant injury to the left atrium. Multiple attempts to repair the left atrial perforation were unsuccessful and the patient died. Case 2: A 71-year old white male presented 29 days after percutaneous RFA for atrial fibrillation with fever and tonic-clonic seizure. Recognition of possible atrio-esophageal fistula was considered and confirmed on thoracotomy. Surgical fixation of the left atria and esophagus were performed. The patient survived and was discharged to a skilled care facility. Case 3: A 75-year old white male presented 24 days after percutaneous RFA for atrial fibrillation with chest pain. An echocardiogram revealed a large pericardial effusion and pericardiocentesis was performed. Despite aggressive measures, the patient died. The autopsy demonstrated a communicating esophageal fistula with the right pulmonary vein. Conclusions: Clinicians tending to patients who have recently undergone atrial ablation need to be aware of atrio-esophageal fistula as a rare but highly fatal complication.

Original languageEnglish (US)
Pages (from-to)847-854
Number of pages8
JournalAmerican Journal of Case Reports
Volume18
DOIs
StatePublished - Aug 1 2017

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Esophageal Fistula
Atrial Fibrillation
Heart Atria
Catheter Ablation
Pulmonary Veins
Thoracotomy
Esophagus
Fever
Pericardiocentesis
Digestive System Endoscopy
Melena
Cryosurgery
Pericardial Effusion
Rare Diseases
Chest Pain
Autopsy
Seizures
Hemorrhage
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Schuring, C. A., Mountjoy, L. J., Priaulx, A. B., Schneider, R. J., Smith, H. L., Wall, G. C., ... Sodhi, A. (2017). Atrio-esophageal fistula: A case series and literature review. American Journal of Case Reports, 18, 847-854. https://doi.org/10.12659/AJCR.903966

Atrio-esophageal fistula : A case series and literature review. / Schuring, Craig A.; Mountjoy, Luke J.; Priaulx, Ashley B.; Schneider, Robert J.; Smith, Hayden L.; Wall, Geoffrey C.; Kadaria, Dipen; Sodhi, Amik.

In: American Journal of Case Reports, Vol. 18, 01.08.2017, p. 847-854.

Research output: Contribution to journalReview article

Schuring, CA, Mountjoy, LJ, Priaulx, AB, Schneider, RJ, Smith, HL, Wall, GC, Kadaria, D & Sodhi, A 2017, 'Atrio-esophageal fistula: A case series and literature review', American Journal of Case Reports, vol. 18, pp. 847-854. https://doi.org/10.12659/AJCR.903966
Schuring CA, Mountjoy LJ, Priaulx AB, Schneider RJ, Smith HL, Wall GC et al. Atrio-esophageal fistula: A case series and literature review. American Journal of Case Reports. 2017 Aug 1;18:847-854. https://doi.org/10.12659/AJCR.903966
Schuring, Craig A. ; Mountjoy, Luke J. ; Priaulx, Ashley B. ; Schneider, Robert J. ; Smith, Hayden L. ; Wall, Geoffrey C. ; Kadaria, Dipen ; Sodhi, Amik. / Atrio-esophageal fistula : A case series and literature review. In: American Journal of Case Reports. 2017 ; Vol. 18. pp. 847-854.
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AU - Schneider, Robert J.

AU - Smith, Hayden L.

AU - Wall, Geoffrey C.

AU - Kadaria, Dipen

AU - Sodhi, Amik

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N2 - Objective: Rare disease Background: Percutaneous catheter radiofrequency ablation (RFA) and cryoablation of the left atrium and pulmonary vein ostia have become successful therapeutic modalities in the management of atrial fibrillation. Atrio-esophageal fistula is a rare complication. Awareness of complication risk is imperative because without prompt diagnosis and urgent surgical intervention, the outcome is often fatal. We present 3 cases of atrio-esophageal fistula following percutaneous catheter radiofrequency ablation (RFA). Case Reports: Case 1: A 72-year old white male presented 27 days after percutaneous RFA for atrial fibrillation with fever, altered mental status, and melena. Esophagogastroduodenoscopy (EGD) revealed a 1-cm defect in the mid-esophagus. Upon thoracotomy, severe hemorrhage ensued from a concomitant injury to the left atrium. Multiple attempts to repair the left atrial perforation were unsuccessful and the patient died. Case 2: A 71-year old white male presented 29 days after percutaneous RFA for atrial fibrillation with fever and tonic-clonic seizure. Recognition of possible atrio-esophageal fistula was considered and confirmed on thoracotomy. Surgical fixation of the left atria and esophagus were performed. The patient survived and was discharged to a skilled care facility. Case 3: A 75-year old white male presented 24 days after percutaneous RFA for atrial fibrillation with chest pain. An echocardiogram revealed a large pericardial effusion and pericardiocentesis was performed. Despite aggressive measures, the patient died. The autopsy demonstrated a communicating esophageal fistula with the right pulmonary vein. Conclusions: Clinicians tending to patients who have recently undergone atrial ablation need to be aware of atrio-esophageal fistula as a rare but highly fatal complication.

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