Case report
Successful Treatment of Atrioesophageal Fistula by Cervical Esophageal Ligation and Decompression

https://doi.org/10.1016/j.athoracsur.2011.01.039Get rights and content

Atrioesophageal fistula is a rare yet devastating complication of transcatheter ablation for atrial fibrillation. This condition requires urgent intervention, but the optimal treatment strategy is yet to be defined. Reported therapies range from endoscopic stenting to direct atrial repair or reconstruction while on cardiopulmonary bypass. Here, we describe the successful management of an atrioesophageal fistula by cervical esophageal ligation and decompression, along with gastric drainage.

Section snippets

Comment

Patients with atrioesophageal fistula typically present 3 to 38 days after cardiac ablation [4], with a mean of 12 days (range, 10 to 16 days) [5]. Presenting symptoms usually include fever, malaise, dysphagia, chest pain, neurologic symptoms, gastrointestinal bleeding, and sepsis. A high level of suspicion for atrioesophageal fistula should exist for patients with these symptoms and a recent atrial ablative procedure. Esophagram with thin barium or water-soluble contrast may show extravasation

Cited by (18)

  • Optimal Approach for Repair of Left Atrial-Esophageal Fistula Complicating Radiofrequency Ablation

    2018, Annals of Thoracic Surgery
    Citation Excerpt :

    A few reports in the literature have described surgical management of this complication. Surgical techniques include esophageal stent placement, cervical esophageal ligation with decompression, and primary surgical repair through a sternotomy or thoracotomy, with or without the use of CPB [3–7]. The optimal approach and technique for repair is unknown.

  • Hyperbaric oxygen therapy for treatment of neurologic sequela after atrioesophageal fistula

    2015, Annals of Thoracic Surgery
    Citation Excerpt :

    Second, the patient underwent successful primary surgical repair of both the atrium and the esophagus without the need for CPB. Previous reports of successful AEF repair have included the use of CPB [5, 6]. Although CPB may be necessary in the event of large atrial defects, the atrial aspect of the fistula in this instance was able to be isolated and controlled without CPB.

  • Magnetic resonance imaging diagnosis of left atrial abscess after ablation of atrial fibrillation

    2013, Annals of Thoracic Surgery
    Citation Excerpt :

    The healed fistula communication between the left atrium and esophagus likely explains the delayed clinical presentation of AE fistula in this patient. Extracardiac and intracardiac repairs of AE fistula have both been reported, with mortality exceeding 50% [2–4]. The intermittent antibiotic use and continuous anticoagulation likely protected the patient and allowed the fistula to heal, with a satisfactory surgical outcome.

View all citing articles on Scopus
View full text