Atrial-esophageal fistula after atrial fibrillation ablation: a case report and literature review

Abstract

Background Atrial-esophageal fistula (AEF) is a rare, but high mortality, complication after catheter ablation. At present, there is no standard treatment for AEF. In this article, we introduce the treatment process of a case diagnosed with AEF and review the latest treatment progress of AEF. Case Description A 65-year-old man, who received catheter ablation 2 weeks prior, presented with fever, chills, and loss of consciousness. Blood cultures grew Streptococcus viridans. A computed tomography (CT) scan of the brain showed a large area of left craniocerebral infarction and air emboli in the right lobe. The chest CT demonstrated air between the left atrium and esophagus, as well as pericardial effusions. Gastroscopy showed an esophageal fistula 35 cm away from the incisor teeth. The patient was diagnosed with AEF, sepsis, and cerebral infarction. An urgent surgical operation and supportive treatments were performed after diagnosis. Eventually, he died of sepsis and multiple organ failure 24 days after surgery. Conclusions We have reported the treatment process of one case diagnosed with AEF and reviewed the latest treatment progress. AEF is a rare but lethal complication after catheter ablation. At present, austere challenges exist in the diagnosis and treatment of AEF. Repeat chest and head CT/magnetic resonance imaging (MRI) are essential for the identification of abnormal manifestations. In terms of treatment, urgent surgical repair is currently recommended once AEF is diagnosed. More attention should be paid to this complication.

More attention should be paid to atrial-esophageal fistula, and not all atrial-esophageal fistulas are iatrogenic

“…Finally, we agree with Wang et al ’s opinion ( 1 ) that austere challenges exist in the diagnosis and treatment of AEF, and more attention should be paid to AEF. Most AEFs are iatrogenic complications of ablation, and our case indicates that AEFs could be caused by non-iatrogenic reasons such as esophagus fish bone.…”

“…More researches about this devastating disease are necessary to improve its prognosis. As reported in that article and many other cases ( 1 , 3 ), most AEFs were regarded as iatrogenic complications. The fact is that not all AEFs are iatrogenic, and we would like to share our experience with a rarer cause of AEF to extend understanding towards this special disease.…”

“…We read the article written by Wang et al in your journal with interest ( 1 ). The article introduced the treatment process of an atrial-esophageal fistula (AEF) and reviewed the latest treatment progress.…”

“…The article introduced the treatment process of an atrial-esophageal fistula (AEF) and reviewed the latest treatment progress. AEF is a rare condition with high mortality, and most AEFs are reported as complications of catheter ablation ( 1 , 2 ). It is a pity that the patient died 24 days after all the medical endeavors.…”