Abstract 15902: Sensitivity of Computed Tomography in Detecting Atrio-esophageal Fistula Following Catheter Ablation for Atrial Fibrillation: A Multi-center Experience and Literature Review
Introduction: Atrio-esophageal (AEF) is a rare but catastrophic complication of atrial fibrillation (AF) ablation procedure. Imaging of the chest by computed tomography (CT) is considered for the diagnosis of AEF, presence of pneumomediastinum or intra-atrial air being the most reliable evidence on CT. However, there are several instances when the CT image was interpreted as normal in the presence of a fistula, especially in the early stage. We present here a systematic review of published reports and unpublished cases from multiple centers anonymously reporting the sensitivity of CT in accurately detecting AEF.
Methods: An extensive literature search was performed on PubMed, MEDLINE and EMBASE databases and reference lists of selected articles for reports on unremarkable CT findings in the presence of AEF developing after catheter ablation for AF. A total of 41 reports were selected. Additionally, 4 unpublished cases collected by our contributing centers were included in the analysis.
Results: Sixty-eight cases (64 reported + 4 unpublished) of AEF following catheter ablation for AF were included in this analysis. All presented with non-specific symptoms such as chest pain, sepsis, fever, neurological abnormalities and leukocytosis, 3-4 weeks after the ablation procedure. Of the 68 cases, initial chest CT was unremarkable or inconclusive in 10 (14.7%) patients, resulting in delay in the diagnosis and therapeutic intervention. Three of the 10 (30%) survived after urgent surgical repair of the fistula following repeat CTs, 1 patient was in critical condition at the time of the publication of the report; the remaining 6 (60%) patients died, 1 after surgery and 5 while awaiting surgery. Diagnosis of AEF was confirmed at autopsy.
Conclusion: Chest CT appears to have limited sensitivity in detecting AEF. Whether this reflects inadequate protocol or interpretation error is unclear. Therefore, under high clinical suspicion, therapeutic decisions should be promptly taken to prevent mortality.
Author Disclosures: S. Mohanty: None. C. Gianni: None. C. Trivedi: None. R. Cataldo: None. J. Kazi: None. R. Riley: None. T. Mattioni: None. D. Riggio: None. M. Zawaneh: None. J. Burkhardt: None. J. Sanchez: None. P. Hranitzky: None. G. Gallinghouse: None. A. Al-Ahmad: None. R. Horton: None. L. Di Biase: Speakers Bureau; Modest; Biotronik, EpiEP, Medtronic, Inc., Janssen Pharmaceuticals, Pfizer, Inc., Boston Scientific Corp.. Consultant/Advisory Board; Modest; Biosense Webster, Inc., St Jude Medical, Stereotaxis, Inc. A. Natale: Speakers Bureau; Modest; Boston Scientific Corp, Biotronik, Medtronic, Inc., Biosense Webster, Inc, St. Jude Medical. Consultant/Advisory Board; Modest; Janssen Pharmaceuticals, St. Jude Medical, Biosense Webster Inc..
- © 2016 by American Heart Association, Inc.