November 19, 2022Pacing and Clinical Electrophysiology

Successful non‐operative management of atrioesophageal fistula after combined therapy of catheter ablation and left atrial appendage closure for atrial fibrillation: A case report

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Why the study?

Atrioesophageal fistula is a rare but devastating complication of radiofrequency catheter ablation for AF with high mortality that usually requires emergency surgery, prompting this report of successful non-operative management.

Can atrioesophageal fistula after catheter ablation and LAAC be successfully managed non-operatively?

Structured PICO

Can atrioesophageal fistula after catheter ablation and LAAC be successfully managed non-operatively?

Population

1 patient with paroxysmal atrial fibrillation who developed atrioesophageal fistula (AEF) 18 days after combined therapy of catheter ablation and percutaneous left atrial appendage closure (LAAC).

Intervention

Non-operative management consisting of early aggressive antibiotic therapy, pericardial drainage, and a fasting state with adequate parenteral nutrition.

Outcome

Improvement of condition with no recurrence of symptoms and disappearance of leaked air on chest CT.

This case demonstrates that early detection and aggressive non-operative management can be a successful treatment strategy for atrioesophageal fistula following AF ablation.

Implication

Nonoperative management may succeed for early-detected AEF after combined ablation-LAAC; leaves open generalizability and should not change practice.

Abstract

Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency ablation (RFCA) for atrial fibrillation (AF) and is associated with high mortality rates. Whereas most cases of AEF are treated by emergency surgical interventions, we report a case of paroxysmal AF with AEF after combined therapy of catheter ablation and percutaneous left atrial appendage closure (LAAC), which was treated successfuly without major surgery or esophageal stenting. He was presented 18 days after the procedure, suffering chest pain, fever, and a transient loss of consciousness. Computed tomography (CT) of the chest disclosed a small accumulation of air in the region of the left atrium adjacent to the esophagus, suggesting AEF. Supported by early aggressive antibiotic therapy, pericardial drainage and a fasting state with adequate parenteral nutrition, resulted in improvement of his condition with no recurrence of symptoms. Subsequent chest CT scans confirmed disappearance of the leaked air and the patient was discharged home 28 days after admission with no neurological compromise. Early detection, rapid treatment and constant awareness of potential fatal consequences are prerequisites for successful treatment of this complication and prevention of fatal outcome.