Atrio-Esophageal Fistula as a Complication of Percutaneous Transcatheter Ablation of Atrial Fibrillation

DOI Web Site 40 Citations
  • Carlo Pappone
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Hakan Oral
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Vincenzo Santinelli
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Gabriele Vicedomini
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Christopher C. Lang
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Francesco Manguso
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Lucia Torracca
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Stefano Benussi
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Ottavio Alfieri
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Robert Hong
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • William Lau
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Kirk Hirata
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Neil Shikuma
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Burr Hall
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
  • Fred Morady
    From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).

Abstract

<jats:p> <jats:bold> <jats:italic>Background—</jats:italic> </jats:bold> Radiofrequency ablation for atrial fibrillation is becoming widely practiced. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods and Results—</jats:italic> </jats:bold> Two patients undergoing circumferential pulmonary vein ablation for atrial fibrillation in different centers developed symptoms compatible with endocarditis 3 to 5 days after the procedure. Their clinical condition deteriorated rapidly, and both suffered multiple gaseous and/or septic embolic events causing cerebral and myocardial damage. One patient survived after emergency cardiac and esophageal surgery; the other died of extensive systemic embolization. An atrio-esophageal fistula was identified in both patients. </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusions—</jats:italic> </jats:bold> Atrio-esophageal fistulas can occur after catheter ablation in the posterior wall of the left atrium. This diagnosis should be excluded in any patient with symptoms or signs of endocarditis after left atrial ablation, and expeditious cardiac surgery is critical if the diagnosis is confirmed. Lower power and temperature settings for applications of radiofrequency energy along the posterior left atrial wall may prevent further cases of fistula formation. </jats:p>

Journal

  • Circulation

    Circulation 109 (22), 2724-2726, 2004-06-08

    Ovid Technologies (Wolters Kluwer Health)

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