https://wikem.org/w/index.php?action=history&feed=atom&title=Atrio-esophageal_fistula%2FenAtrio-esophageal fistula/en - Revision history2026-04-20T02:05:48ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Atrio-esophageal_fistula/en&diff=380050&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-06T21:17:33Z<p>Updating to match new version of source page</p>
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==Background==<br />
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[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]]<br />
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]]<br />
[[File:Illu esophagus.jpg|thumb|Esophagus anatomy and nomenclature based on two systems.]]<br />
[[File:PMC2922872 ipej100339-08.png|thumb|CT showing anatomic relationship between an enlarged left atrium (LA) and esophagus (ESO): atrium abuts and indents into the anterior wall of the esophagus.]]<br />
*Rare but deadly complication of atrial [[Special:MyLanguage/Cardiac ablation complications|ablation]]<br />
*There have been reported cases with various ablation modalities (including radiofrequency ablation, cryoablation, high intensity focused ultrasound, and surgical ablation)<br />
*Incidence is low (<0.1%) <ref> Nair KK, Danon A, Valaparambil A, Koruth JS, Singh SM. Atrioesophageal Fistula: A Review. J Atr Fibrillation. 2015;8(3):1331. Published 2015 Oct 31. doi:10.4022/jafib.1331 </ref><br />
*Usually formed between esophagus and left atrium<br />
*Thought to be related to adverse healing secondary to esophageal injury during the ablation procedure<br />
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==Clinical Features==<br />
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*Most common presenting symptoms:<br />
**[[Special:MyLanguage/Fever|Fever]]<br />
**Neurological symptoms (including [[Special:MyLanguage/focal neurological symptoms|focal neurological symptoms]], [[Special:MyLanguage/seizure|seizure]], [[Special:MyLanguage/AMS|AMS]])<br />
**Gastrointestinal symptoms (including [[Special:MyLanguage/hematemesis|hematemesis]], [[Special:MyLanguage/melena|melena]], [[Special:MyLanguage/dysphagia|dysphagia]], [[Special:MyLanguage/nausea/vomiting|nausea/vomiting]])<br />
**[[Special:MyLanguage/Chest pain|Chest pain]]<br />
*Most common time frame to presentation is 2-4 weeks post procedure but can occur up to 2 months post procedure<br />
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==Differential Diagnosis==<br />
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*[[Special:MyLanguage/Sepsis|Sepsis]]<br />
*[[Special:MyLanguage/Stroke|Stroke]]/[[Special:MyLanguage/TIA|TIA]]<br />
*[[Special:MyLanguage/GI bleed|GI bleed]]<br />
{{Chest Pain DDX}}<br />
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==Evaluation==<br />
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[[File:PMC3631790 kjtcs-46-142-g003.png|thumb|Chest CT demonstrating pneumomediastinum after cardiac radiofrequency catheter ablation for refractory atrial fibrillation.]]<br />
*CT chest with contrast is the recommended modality, but repeat testing may be needed for eventual diagnosis <ref> Han H-C, Hui-Chen Han From the Austin Health, Ha FJ, et al. Atrioesophageal Fistula. Circulation: Arrhythmia and Electrophysiology. https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.005579. Published November 6, 2017. Accessed December 14, 2020. </ref><br />
*Endoscopy may be considered, but may be associated an increased risk of clinical deterioration<br />
*Transthoracic and transesophageal echocardiography have not been found to be highly sensitive<br />
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==Management==<br />
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*Mortality is high in all patients <br />
*Surgery has the best mortality benefit, followed by endoscopic intervention<br />
*Nonintervention has the worst outcome<br />
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==Disposition==<br />
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*Admission<br />
*Surgery consultation<br />
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==See Also==<br />
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==External Links==<br />
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==References==<br />
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<references/><br />
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[[Category:Surgery]]<br />
[[Category:Cardiology]]<br />
[[Category:GI]]</div>FuzzyBot