Immediate surgery for esophageal perforation after AF ablation resulted in survival without neurologic residues in 2 patients, whereas delayed treatment led to death (n=2) or permanent deficits (n=1).
Case Report (n=5)
Does rapid surgical treatment improve survival and prevent neurologic complications in patients with esophageal perforation after radiofrequency ablation for atrial fibrillation?
Immediate surgical intervention for esophageal perforation after atrial fibrillation ablation is crucial to prevent devastating neurologic complications and death.
INTRODUCTION: The aim of the study was to identify criteria for rapid recognition and successful treatment of esophageal perforation after radiofrequency ablation for atrial fibrillation (AF). METHODS AND RESULTS: Esophageal perforation occurred in five patients after intraoperative (n = 4) or percutaneous (n = 1) AF ablation. Patients presented with high fever (n = 3) or severe chest/epigastric pain (n = 2) 8-28 days after ablation. WBC count was elevated at presentation in all patients (15,460 +/- 2,910/muL), CRP showed a delayed rise. Thoracic CT detected free air in all. Neurologic complications occurred in three cases (60%) with a delay of 5-40 hours after first symptoms. Only one (20%) developed neurologic complications within the first 24 hours. Two patients (40%) died before surgery could be performed. In both, time from symptom onset to diagnosis was significant (24 and 36 hours). Three patients (60%) underwent esophageal resection and survived. In two of them, treatment was rapid with time from symptoms to surgery of 24 hours; they had favorable outcome. In the third surviving patient, surgery was late (5 days after first symptoms); permanent neurologic residues remained. CONCLUSION: The leading symptom of esophageal perforation is high fever or severe chest/epigastric pain. Fever is not necessarily present. Leukocytosis is the earliest and most sensitive laboratory marker, thoracic CT the most valuable diagnostic examination. The dramatic neurologic complications occur with a delay of at least a few hours after first symptoms. Immediate surgery may prevent neurologic complications and could possibly result in a high survival rate without residues. Delay of treatment seems to have devastating results.
Dagres et al. (2006) conducted a case report in Esophageal perforation after radiofrequency ablation for atrial fibrillation (n=5). Immediate surgery was evaluated on Survival and neurologic complications. Immediate surgery for esophageal perforation after AF ablation resulted in survival without neurologic residues in 2 patients, whereas delayed treatment led to death (n=2) or permanent deficits (n=1).