Surgical technique for atrial-esophageal fistula repair after catheter ablation: An underrecognized complication.
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ABSTRACT:
SUBMITTER: Guenthart BA
PROVIDER: S-EPMC8303005 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
Publications
Surgical technique for atrial-esophageal fistula repair after catheter ablation: An underrecognized complication.
Guenthart Brandon A BA Sun Beatrice B De Biasi Andreas A Fischbein Michael P MP Liou Douglas Z DZ
JTCVS techniques 20200805
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Project description:Left atrial-esophageal fistula (LAEF) is a rare complication of radiofrequency ablation (RFA) procedures undertaken for atrial fibrillation (AF). This complication is associated with significant morbidity and mortality. Currently, there is no clear consensus on the appropriate management strategy. We report a case of a LAEF that developed in a patient 2 weeks after RFA for medication refractory AF. The patient underwent successful repair of the fistula through a left posterolateral thoracotomy, wherein the esophageal and atrial lesions were repaired primarily with an intercostal muscle flap and bovine pericardial patch to reinforce and prevent recurrence.
| S-EPMC4176074 | biostudies-other
Project description: Not available
| S-EPMC1860761 | biostudies-literature
Project description:Atrio-esophageal fistula (AEF) is one of the most devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) and surgical repair is strongly recommended. However, optimal surgical approach remains to be elucidated. We retrospectively reviewed AEF cases that occurred after RFCA in a single center and evaluated the clinical results of different surgical approach. Surgical or endoscopic repair was attempted in five AF patients who underwent RFCA. Atrio-esophageal fistula and mediastinal infection was not controlled in the patient who underwent endoscopic repair eventually died. Lethal cerebral air embolism occurred two days after surgery in a patient who underwent esophageal repair only. Primary surgical repair of both the left atrium (LA) and esophagus was performed in the remaining three patients. Among these three patients, two underwent external LA repair and the remaining had internal LA repair via open-heart surgery. External repair of the LA was unsuccessful and one patient dies and another had to undergo second operation with internal repair of the LA. The patient who underwent internal LA repair during the first operation survived without additional surgery. Furthermore, we applied veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with artificial induction of ventricular fibrillation in this patient to prevent air and septic embolism and she had no neurologic sequelae. In summary, surgical correction can be considered preferentially to correct AEF. Open-heart surgical repair of LA from the internal side seems to be an acceptable surgical method. Application of VA-ECMO with artificial induction of ventricular fibrillation might be effective to prevent air and septic embolism.
| S-EPMC7235255 | biostudies-literature
Project description: Not available
| S-EPMC11632334 | biostudies-literature
Project description: Not available
| S-EPMC5420036 | biostudies-literature
Project description:BackgroundAtrial-esophageal fistula (AEF) is a rare, but high mortality, complication after catheter ablation. At present, there is no standard treatment for AEF. In this article, we introduce the treatment process of a case diagnosed with AEF and review the latest treatment progress of AEF.Case descriptionA 65-year-old man, who received catheter ablation 2 weeks prior, presented with fever, chills, and loss of consciousness. Blood cultures grew Streptococcus viridans. A computed tomography (CT) scan of the brain showed a large area of left craniocerebral infarction and air emboli in the right lobe. The chest CT demonstrated air between the left atrium and esophagus, as well as pericardial effusions. Gastroscopy showed an esophageal fistula 35 cm away from the incisor teeth. The patient was diagnosed with AEF, sepsis, and cerebral infarction. An urgent surgical operation and supportive treatments were performed after diagnosis. Eventually, he died of sepsis and multiple organ failure 24 days after surgery.ConclusionsWe have reported the treatment process of one case diagnosed with AEF and reviewed the latest treatment progress. AEF is a rare but lethal complication after catheter ablation. At present, austere challenges exist in the diagnosis and treatment of AEF. Repeat chest and head CT/magnetic resonance imaging (MRI) are essential for the identification of abnormal manifestations. In terms of treatment, urgent surgical repair is currently recommended once AEF is diagnosed. More attention should be paid to this complication.
| S-EPMC9929749 | biostudies-literature
Project description:BackgroundEsophageal thermal injury is a complication of atrial fibrillation (AF) ablation, and it can be avoided by esophageal deviation during left atrial posterior wall radiofrequency catheter ablation.ObjectiveThis study aimed to evaluate the safety of a nitinol-based mechanical esophageal displacement device (MEDD) and its performance.MethodsThis preclinical safety study was conducted on 20 pigs, with 10 undergoing radiofrequency AF ablation using the MEDD and 10 serving as a control group under anticoagulation but without radiofrequency application. Esophageal traumatic injuries were classified from 0 to 4 and were grouped as absent (grade 0), minor (grade 1 or 2), moderate (grade 3), or major risk lesions (grade 4) by anatomopathological study. Grades 1 and 2 were considered acceptable. Fluoroscopy was used to measure displacement.ResultsFive (25%) pigs developed traumatic lesions, 4 with grade 1 and 1 with grade 2 (2-mm superficial ulcer). There was no difference in lesion occurrence between the radiofrequency and control groups (30% and 20%, respectively; P = .43). Under rightward displacement, the right edge moved 23.9 (interquartile range [IQR] 21.3-26.3) mm and the left edge moved 16.3 (IQR 13.8-18.4) mm (P < .001) from baseline. Under leftward displacement, the right edge moved 13.5 (IQR 10.9-15.3) mm and the left edge moved 16.5 (IQR 12.3-18.5) mm (P = .07). A perforation to the pharyngeal diverticulum occurred in 1 pig, related to an accidental extubation.ConclusionIn pigs, the MEDD demonstrated safety in relation to esophageal tissue, and successful deviation. Esophageal traumatic injuries were acceptable, but improper manipulation led to pharyngeal lesion.
| S-EPMC10513920 | biostudies-literature
Project description:Pericardial-esophageal fistula is a rare complication after radiofrequency ablation for atrial fibrillation. A 52-year-old man developed pneumopericardium, which was revealed by echocardiogram and computed tomography, after a combined ablation and left atrial appendage occlusion procedure for atrial fibrillation. He was diagnosed with a pericardial-esophageal fistula and underwent surgical pericardial and mediastinal drainage tube placement. However, the patient developed constrictive pericarditis 2 months after the first surgery and subsequently underwent pericardiolysis. A month after the second surgery, the patient's condition was significantly improved and he was allowed home.
| S-EPMC11646909 | biostudies-literature
Project description:Although pulmonary veins stenosis (PVS) is a well documented complication of radiofrequency-catheter ablation (RFCA) of atrial fibrillation (AF), simultaneous involvement of multiple PVs is extremely rare. We present the case of a 69 years-old male patient, with prior medical history of persistent AF, who had been treated with RFCA two years ago. After RFCA, he started with shortness of breath and needed hospitalization for bilateral pneumonia. One year after the procedure, he was on home oxygen, but still referred dyspnea, cough and hemoptysis. A transthoracic echocardiogram showed moderate right ventricular (RV) systolic dysfunction and elevated RV systolic pressure. Dedicated cardiac tomography for PV assessment revealed severe narrowing and pre-stenotic engorgement of all 5 PVs, with subtotal ostial occlusion of both the left lower and right middle PVs. PV angiography confirmed the diagnosis. Only the left and right upper PV were able to be wire-crossed and stented, with substantial reductions in stenosis from 90 % to 10 %. After 3 months of follow-up, the patient improved substantially, and home O2 was withdrawn.
| S-EPMC9483592 | biostudies-literature
Project description:Atrioesophageal fistula is a rare, devastating complication of atrial fibrillation ablation, reportedly occurring in 0.015-0.04% of catheter ablations. A 66-year-old African American male with a past medical history of chronic atrial fibrillation status post recent radiofrequency ablation and on chronic anticoagulation with rivaroxaban presented with left upper extremity numbness, tingling, and transient weakness. He was admitted for a cerebrovascular accident workup; a 12-lead electrocardiogram revealed atrial fibrillation and magnetic resonance imaging of the brain was consistent with multifocal embolic infarcts. Hospital course was further complicated by persistent high-grade fevers, gram-positive bacteremia, and worsening mental status requiring mechanical ventilation. Lumbar puncture was consistent with bacterial meningitis. Transthoracic echocardiogram was negative for vegetations. Computed tomography angiography of the chest with intravenous contrast revealed an outpouching off the posterior wall of the left atrium at the level of the inferior pulmonary vein, consistent with an atrioesophageal fistula. We present this case to highlight the clinical features of a rare but potentially fatal complication from a commonly performed procedure requiring prompt recognition and life-saving intervention.
| S-EPMC7381424 | biostudies-literature