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Approaches to the Diagnosis and Management of Atrial-Esophageal Fistula After Catheter Ablation for Atrial Arrhythmias

  • Tan Chen WuEmail author
  • Cristiano Pisani
  • Maurício I. Scanavacca
Arrhythmias (J. Bunch, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Arrythmias

Abstract

Purpose of Review

Catheter ablation has become a cornerstone of therapy in the management of patients with atrial fibrillation (AF). Thermal energy generated in the left atrium (LA) during ablation has the potential to damage adjacent structures. The most feared and rare complication in these ablations is atrial-esophageal fistula (AEF) result from the thermal injury to the esophagus due to the proximity to the LA, with potential catastrophic outcome. This review focuses on the diagnosis and management of AEF after catheter ablation for AF, including preventive measures to avoid esophageal lesions.

Recent Findings

Symptoms of AEF are often vague and nonspecific, sometimes asymptomatic until they present with fistula or perforation, making the diagnosis somewhat challenging. The esophagogastroduodenoscopy is the gold standard for early detection of esophageal lesions related to AF ablation. Chest CT with oral and intravenous contrast is preferred when there is suspicion of perforation. The use of an esophageal temperature probe during ablation to monitoring esophageal temperature, associated with mechanical displacement of the esophagus, may be feasible to prevent thermal esophageal lesions and enabling adequate energy delivery to the posterior wall of the LA. Prophylactic use of proton pump inhibitors after AF ablation is accepted to be effective and justified as preventive treatment.

Summary

AEF is an unpredictable complication. Be aware of these complications in the follow-up of patients after AF ablation can lead to the early recognition to start treatment, including surgical repair, as soon as possible to prevent the fatal outcome.

Keywords

Atrial fibrillation Catheter ablation Pulmonary vein isolation Esophageal injury Atrial-esophageal fistula 

Abbreviations

AEF

Atrial-esophageal fistula

AF

Atrial fibrillation

CT

Computer tomography

EGD

Esophagogastroduodenoscopy

LA

Left atrium

MR

Magnetic resonance

NPO

Nir per os

PPIs

Proton pump inhibitors

PV

Pulmonary vein

RF

Radiofrequency

Notes

Compliance with Ethical Standards

Conflict of Interest

Tan Chen Wu, Cristiano Pisani, and Maurício Scanavacca declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Tan Chen Wu
    • 1
    Email author
  • Cristiano Pisani
    • 1
  • Maurício I. Scanavacca
    • 1
  1. 1.Arrhythmia Unit, Heart InstituteUniversity of São Paulo Medical SchoolSão PauloBrazil

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