Successful Nonsurgical Treatment of Esophagopericardial Fistulas After Atrial Fibrillation Catheter Ablation

DOI Web Site 被引用文献1件
  • Charlotte Eitel
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).
  • Sascha Rolf
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).
  • Markus Zachäus
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).
  • Silke John
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).
  • Philipp Sommer
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).
  • Andreas Bollmann
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).
  • Arash Arya
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).
  • Christopher Piorkowski
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).
  • Gerhard Hindricks
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).
  • Ulrich Halm
    From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.).

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  • A Case Series

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<jats:sec> <jats:title>Background—</jats:title> <jats:p>Esophageal perforations are a rare but devastating complication of atrial fibrillation catheter ablation. Rapid treatment is crucial to avoid permanent disabilities and death. Surgical treatment is considered the treatment of choice. Alternatively, single case reports describe successful esophageal stenting, but others discourage this approach because of fatal consequences.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p>We present 3 patients who developed esophagopericardial fistulas after radiofrequency catheter ablation of atrial fibrillation. Diagnosis and management with pericardial drainage and esophageal stenting, as well as long-term follow-up are described. Esophagopericardial fistulas occurred 26, 9, and 18 days after the ablation procedure. Symptoms leading to admission were recurrence of atrial fibrillation (n=1), elective control endoscopy for thermal lesion (n=1), and pain with swallowing (n=1). Computed tomography revealed esophagopericardial fistulas with pericardial effusion in all patients, while contrast leakage and air in the left atrium could be excluded. Broad-spectrum antibiotics were initialized, and minimally invasive pericardial drainage and esophageal stenting were performed. Stent dislocation occurred in 2 patients and was resolved by repositioning and clipping of the proximal stent end. After 45, 22, and 28 days, respectively, fistulas appeared closed and stents were removed. During follow-up, no embolic or septic events occurred. However, 2 patients underwent dilation of symptomatic esophageal stenosis in the formerly stented region.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>An early minimally invasive approach consisting of pericardial drainage and esophageal stenting proved effective in treating patients with esophagopericardial fistulas. However, constant interdisciplinary communication and attention is needed to recognize and manage potential evolving complications promptly.</jats:p> </jats:sec>

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