Successful non-operative management of left atrioesophageal fistula following catheter ablation

Surg Today. 2014 Aug;44(8):1565-8. doi: 10.1007/s00595-013-0744-9. Epub 2013 Oct 3.

Abstract

Atrioesophageal fistula (AEF) is a potentially lethal complication of catheter radiofrequency ablation for atrial fibrillation. A 49-year-old man with paroxysmal atrial fibrillation who underwent catheter ablation around the pulmonary vein was admitted 31 days after the procedure, suffering seizures and fever. Magnetic resonance imaging of the brain showed ischemia and multiple lesions of acute infarction in the right occipital lobe of the cerebrum. Computed tomography (CT) of the chest showed a small accumulation of air between the posterior left atrium and the esophagus, suggesting an AEF. Endoscopic snaring of the esophageal mucosa, repeated a few times, supported by nil by mouth and antibiotic therapy, resulted in improvement of his condition with no recurrence of symptoms. Subsequent chest CT scans confirmed disappearance of the leaked air and the patient was discharged home 45 days after admission with no neurological compromise.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Atrial Fibrillation / surgery*
  • Brain Ischemia / diagnosis
  • Brain Ischemia / etiology
  • Catheter Ablation / adverse effects*
  • Cerebral Infarction / diagnosis
  • Cerebral Infarction / etiology
  • Esophageal Fistula / diagnostic imaging
  • Esophageal Fistula / etiology*
  • Esophageal Fistula / therapy*
  • Esophagoscopy
  • Fistula / diagnostic imaging
  • Fistula / etiology*
  • Fistula / therapy*
  • Heart Atria
  • Heart Diseases / diagnostic imaging
  • Heart Diseases / etiology*
  • Heart Diseases / therapy*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Occipital Lobe
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / etiology*
  • Postoperative Complications / therapy*
  • Pulmonary Veins
  • Tomography, X-Ray Computed
  • Treatment Outcome