Circulation. 2004;109:2724-2726
Published online before print May 24, 2004, doi: 10.1161/01.CIR.0000131866.44650.46
Published online before print May 24, 2004, doi: 10.1161/01.CIR.0000131866.44650.46
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(Circulation. 2004;109:2724-2726.)
© 2004 American Heart Association, Inc.
Brief Rapid Communications |
Atrio-Esophageal Fistula as a Complication of Percutaneous Transcatheter Ablation of Atrial Fibrillation
From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
Correspondence to Carlo Pappone, MD, Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. E-mail carlo.pappone{at}hsr.it
Received March 19, 2004; revision received April 20, 2004; accepted April 27, 2004.
Background— Radiofrequency ablation for atrial fibrillation is becoming widely practiced.
Methods and Results— Two patients undergoing circumferential pulmonary vein ablation for atrial fibrillation in different centers developed symptoms compatible with endocarditis 3 to 5 days after the procedure. Their clinical condition deteriorated rapidly, and both suffered multiple gaseous and/or septic embolic events causing cerebral and myocardial damage. One patient survived after emergency cardiac and esophageal surgery; the other died of extensive systemic embolization. An atrio-esophageal fistula was identified in both patients.
Conclusions— Atrio-esophageal fistulas can occur after catheter ablation in the posterior wall of the left atrium. This diagnosis should be excluded in any patient with symptoms or signs of endocarditis after left atrial ablation, and expeditious cardiac surgery is critical if the diagnosis is confirmed. Lower power and temperature settings for applications of radiofrequency energy along the posterior left atrial wall may prevent further cases of fistula formation.
Key Words: arrhythmia • ablation • surgery • fistula
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