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ARTICLE

Brief Communication: Atrial–Esophageal Fistulas after Radiofrequency Ablation

Jennifer E. Cummings, MD; Robert A. Schweikert, MD; Walid I. Saliba, MD; J. David Burkhardt, MD; Fethi Kilikaslan, MD; Eduardo Saad, MD; and Andrea Natale, MD

18 April 2006 | Volume 144 Issue 8 | Pages 572-574

Background: Ablation of atrial fibrillation is generally considered safe and effective. However, atrial–esophageal fistulas have recently been reported as a rare but fatal complication.

Objective: To describe 9 patients with atrial–esophageal fistulas after ablation for atrial fibrillation.

Design: Retrospective case series.

Setting: Institutions where cardiologists performed atrial fibrillation ablation procedures.

Patients: 9 patients with atrial–esophageal fistulas after atrial fibrillation ablation.

Measurements: Demographic characteristics, mortality, presenting signs and symptoms, and days to presentation.

Results: Patients presented a mean of 12.3 days (range, 10 to 16 days) after their procedures. Nonspecific symptoms included fever, leukocytosis, and neurologic abnormalities. All patients died. Only 4 patients received correct diagnoses before death, although all patients presented to a physician. In 3 patients, surgical repair was attempted.

Limitations: Few physicians reported cases, and only approximate numbers of procedures performed by the physicians are known. Thus, the authors could not estimate the incidence of atrial–esophageal fistulas after ablation.

Conclusions: Formation of atrial–esophageal fistulas is a rare but potentially devastating complication of atrial fibrillation ablation. This disorder may have an indolent presentation and may mimic other disease states, such as stroke or sepsis.

Editors' Notes Context Cardiologists sometimes use catheter radiofrequency ablation procedures near the posterior wall of the left atrium to cure atrial fibrillation. Contribution This retrospective case series describes 9 patients with atrial–esophageal fistulas following catheter ablation for atrial fibrillation. They presented 10 to 16 days after the procedure with nonspecific findings, such as fever, leukocytosis, and neurologic abnormalities. All died. Only 4 received correct diagnoses before death. Cautions Case reports cannot establish how often ablation-related atrial–esophageal fistulas occur. Implications Atrial–esophageal fistulas that occur after ablation procedures involving the left atrium may have an indolent yet ultimately catastrophic presentation. —The Editors

 

Author and Article Information

From The Cleveland Clinic, Cleveland, Ohio, and Hospital Pró-Cardíaco, Rio de Janeiro, Brazil.

Grant Support: None.

Potential Financial Conflicts of Interest: Consultancies: J.D. Burkhardt (Biosense Webster); Honoraria: R.A. Schweikert (Siemens Acuson); Grants received: A. Natale (Siemens, Biosense Webster).

Requests for Single Reprints: Jennifer E. Cummings, MD, Department of Cardiovascular Medicine, Section of Electrophysiology and Pacing, 9500 Euclid Avenue Desk F-15, Cleveland, OH 44195.

Current Author Addresses: Drs. Cummings, Schweikert, Saliba, Burkhardt, Kilikaslan, and Natale: Department of Cardiovascular Medicine, Section of Electrophysiology and Pacing, 9500 Euclid Avenue Desk F-15, Cleveland, OH 44195.

Dr. Saad: Hospital Pró-Cardíaco, 2607/303 Avenida Borges de Medeiros, 22470-001 Rio de Janeiro, Brazil.

Author Contributions: Conception and design: J.E. Cummings, F. Kilikaslan, E. Saad, A. Natale.

Analysis and interpretation of the data: J.E. Cummings, R.A. Schweikert, A. Natale.

Drafting of the article: J.E. Cummings, R.A. Schweikert, J.D. Burkhardt, F. Kilikaslan, A. Natale.

Critical revision of the article for important intellectual content: J.E. Cummings, R.A. Schweikert, W.I. Saliba, J.D. Burkhardt, E. Saad, A. Natale.

Final approval of the article: J.E. Cummings, R.A. Schweikert, W.I. Saliba, J.D. Burkhardt, E. Saad, A. Natale.

Provision of study materials or patients: E. Saad.

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