Abstract 16235: Atrioesophageal Fistula Following Ablation Procedures for Atrial Fibrillation: A Case Series
Background: Atrioesophageal fistula (AEF) is a rare but serious adverse event of atrial fibrillation (AF) ablation. We reviewed 54 reported cases to characterize the clinical presentation and prognosis of this entity.
Objective: To identify the clinical characteristics of AEF following ablation procedures for AF and determine the associated mortality.
Methods: We performed a systematic literature search of observational cases of AEF following ablation for AF.
Statistical analysis: Descriptive statistics.
Results: Fifty-four cases were identified. Fever was the most common presenting symptom (n=42) followed by neurological deficits (n=27; including motor and language impairment), hematemesis (n=17); altered mental status (n=15), chest pain (n=14) and seizures (n=7). The mean presentation time after ablation procedure was 20±11 days, with a 2-60 day range. The techniques performed were: Percutaneous RFA (PRFA) in 37 cases, surgical RFA (SRFA) in 15 cases, cryothermal ablation in 1 case and HIFU in 1 case as well. CT of the chest and head (n=29; n=14 respectively) were the preferred diagnostic modalities, with multifocal infarcts consistent with air embolism (n=14) and pneumomediastinum (n=12) as the most common findings. Broad-spectrum antibiotics were given in 20 cases, although an identifiable microorganism was present in only 10 patients. Surgical repair was the therapy of choice in 25 cases, while no intervention was possible in 22 cases. At least one fatal outcome was observed after transesophageal echocardiography (TEE). Overall mortality was 35% (n=19) among them 5 cases, which did not have any intervention.
Conclusions: Atrioesophageal fistula in the sequence of AF ablation procedures has a grave prognosis with a high mortality. Fever of unknown origin and/or septicemia after ablation is a contraindication for TEE until AEF has been ruled out.
Figure. Frequency and distribution of symptoms in atrioesophageal fistula following ablation for AF.
- © 2013 by American Heart Association, Inc.