Abstract
The purpose of this review is to understand the epidemiology, clinical features, etiopathogenesis,
and management of atrioesophageal fistula (AEF) after atrial fibrillation (AF) ablation.
The incidence of AEF after AF ablation is 0.015%-0.04%. The principal clinical features
include fever, dysphagia, upper gastrointestinal bleeding, sepsis, and embolic strokes.
The close proximity of the esophagus to the posterior left atrial wall is responsible
for esophageal injury during ablation. Prophylactic proton pump inhibitors, esophageal
temperature monitoring, visualization of the esophagus during catheter ablation, esophageal
protection devices, and avoidance of energy delivery in close proximity to the esophagus
play an important role in preventing esophageal injury. Early surgical repair or esophageal
stenting are the mainstay of treatment. Eliminating esophageal injury during AF ablation
is of utmost importance in preventing AEF. A high index of suspicion and early intervention
is necessary to prevent fatal outcomes.
Résumé
Le but de cette revue est de comprendre l’épidémiologie, les caractéristiques cliniques,
l’étiopathogenèse et la prise en charge de la fistule atrio-œsophagienne après l’ablation
de la fibrillation auriculaire (FA). La fréquence de la fistule atrio-œsophagienne
après l’ablation de la FA est de 0,015 % à 0,04 %. Les principales caractéristiques
cliniques incluent la fièvre, la dysphagie, le saignement dans le tractus gastro-intestinal
supérieur, la sepsie et les accidents vasculaires cérébraux d’origine embolique. La
proximité immédiate de l’œsophage et de la paroi postérieure de l’oreillette gauche
est responsable des lésions œsophagiennes au cours de l’ablation. Les inhibiteurs
de la pompe à protons en prophylaxie, la surveillance de la température œsophagienne,
la visualisation de l’œsophage au cours de l’ablation par cathéter, les dispositifs
de protection de l’œsophage et l’évitement des sources d’énergie à proximité immédiate
de l’œsophage jouent un rôle important dans la prévention des lésions œsophagiennes.
La réparation chirurgicale précoce ou la pose d’une endoprothèse œsophagienne constituent
le pilier du traitement. L’élimination des lésions œsophagiennes au cours de l’ablation
de la FA est de la plus grande importance dans la prévention de la fistule atrio-œsophagienne.
Un indice élevé de suspicion et une intervention précoce sont nécessaires pour que
l’issue ne soit pas fatale.
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Article info
Publication history
Published online: December 23, 2013
Accepted:
December 17,
2013
Received:
October 29,
2013
Footnotes
See page 394 for disclosure information.
Identification
Copyright
© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Stenting for Atrioesophageal FistulaCanadian Journal of CardiologyVol. 30Issue 10
- PreviewWe appreciated Dr Nair and colleagues' excellent review1 on atrioesophageal fistula (AEF) associated with catheter ablation of atrial fibrillation. It is indeed a rare, but catastrophic complication of a fairly common ablation procedure. Because our collective experience with this complication is limited, commenting on the optimal management strategy is difficult. We wish to elaborate on what we believe is a very important point regarding management of AEF. Nair et al. state that successful nonsurgical treatment with esophageal stenting has been reported.
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