Atrio-esophageal fistula: Difference between revisions

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==Background==
==Background==
[[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.]]
[[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.]]
*Rare but deadly complication of atrial ablation
*Rare but deadly complication of atrial [[Cardiac ablation complications|ablation]]
*There have been reported cases with various ablation modalities (including radiofrequency ablation, cryoablation, high intensity focused ultrasound, and surgical ablation)
*There have been reported cases with various ablation modalities (including radiofrequency ablation, cryoablation, high intensity focused ultrasound, and surgical ablation)
*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>
*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>
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==Clinical Features==
==Clinical Features==
*Most common presenting symptoms:
*Most common presenting symptoms:
**Fever
**[[Fever]]
**Neurological symptoms (including focal neurological symptoms, seizure, AMS)
**Neurological symptoms (including [[focal neurological symptoms]], [[seizure]], [[AMS]])
**Gastrointestinal symptoms (including hematemesis, melena, dysphagia, nausea/vomiting)
**Gastrointestinal symptoms (including [[hematemesis]], [[melena]], [[dysphagia]], [[nausea/vomiting]])
**Chest pain
**[[Chest pain]]
*Most common time frame to presentation is 2-4 weeks post procedure but can occur up to 2 months post procedure
*Most common time frame to presentation is 2-4 weeks post procedure but can occur up to 2 months post procedure


==Differential Diagnosis==
==Differential Diagnosis==
*Sepsis
*[[Sepsis]]
*Stroke/TIA
*[[Stroke]]/[[TIA]]
*GI bleed
*[[GI bleed]]
{{Chest Pain DDX}}
{{Chest Pain DDX}}


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[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Cardiology]]
[[Category:GI]]

Revision as of 15:46, 8 February 2021

Background

CT showing anatomic relationship between an enlarged left atrium (LA) and esophagus (ESO): atrium abuts and indents into the anterior wall of the esophagus.
  • Rare but deadly complication of atrial ablation
  • There have been reported cases with various ablation modalities (including radiofrequency ablation, cryoablation, high intensity focused ultrasound, and surgical ablation)
  • Incidence is low (<0.1%) [1]
  • Usually formed between esophagus and left atrium
  • Thought to be related to adverse healing secondary to esophageal injury during the ablation procedure

Clinical Features

Differential Diagnosis

Chest pain

Critical

Emergent

Nonemergent

Evaluation

Chest CT demonstrating pneumomediastinum after cardiac radiofrequency catheter ablation for refractory atrial fibrillation.
  • CT chest with contrast is the recommended modality, but repeat testing may be needed for eventual diagnosis [2]
  • Endoscopy may be considered, but may be associated an increased risk of clinical deterioration
  • Transthoracic and transesophageal echocardiography have not been found to be highly sensitive

Management

  • Mortality is high in all patients
  • Surgery has the best mortality benefit, followed by endoscopic intervention
  • Nonintervention has the worst outcome

Disposition

  • Admission
  • Surgery consultation

See Also

External Links

References

  1. 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
  2. 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.