Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting

Sanghamitra Mohanty, Pasquale Santangeli, Prasant Mohanty, Luigi Di Biase, Chintan Trivedi, Rong Bai, Rodney Horton, J. David Burkhardt, Javier E. Sanchez, Jason Zagrodzky, Shane Bailey, Joseph G. Gallinghouse, Patrick M. Hranitzky, Albert Y. Sun, Richard Hongo, Salwa Beheiry, Andrea Natale

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Management of Atrioesophageal Fistula Post-AF Ablation Introduction Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies. Methods Nine patients with AEF post-RFCA for AF were included in this study. AEF was diagnosed based on symptoms and chest CT imaging. Of the 9 patients, 5 received stents and 4 underwent surgical repair of fistula. Results AF ablation was performed under general anesthesia (n = 4) or conscious sedation (n = 5). During ablation, RF power was maintained between 25 and 35 Watts in areas close to the esophagus and energy delivery discontinued when esophageal temperature reached 38 °C. Seven patients underwent ablation with 3.5-mm open-irrigated catheter, 1 with 8-mm nonirrigated catheter, and 1 had surgical epicardial ablation. Seven patients received proton pump inhibitor and sucralfate before and after procedure. AEF symptoms developed within 2-6 weeks from ablation. Esophageal stenting was performed in 5 patients (median age 58 years, median time from RFCA 4 weeks) and 4 underwent surgical repair (median age 54 years, median time from RFCA 4 weeks) within 2-4 hours from diagnosis. All 5 patients receiving stents died within 1 week of the procedure due to cerebral embolism, septic shock, or respiratory failure. On the other hand, the 4 patients that received surgical repair were alive at median follow-up of 2.1 years (P = 0.005). Conclusions Esophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.

Original languageEnglish (US)
Pages (from-to)579-584
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Catheter Ablation
Atrial Fibrillation
Fistula
Stents
Catheters
Sucralfate
Conscious Sedation
Intracranial Embolism
Proton Pump Inhibitors
Septic Shock
Respiratory Insufficiency
General Anesthesia
Esophagus
Thorax
Temperature
Survival

Keywords

  • atrial fibrillation
  • atrioesophageal fistul
  • esophageal stent
  • radiofrequency catheter ablation
  • surgical repair of fistula

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting. / Mohanty, Sanghamitra; Santangeli, Pasquale; Mohanty, Prasant; Di Biase, Luigi; Trivedi, Chintan; Bai, Rong; Horton, Rodney; Burkhardt, J. David; Sanchez, Javier E.; Zagrodzky, Jason; Bailey, Shane; Gallinghouse, Joseph G.; Hranitzky, Patrick M.; Sun, Albert Y.; Hongo, Richard; Beheiry, Salwa; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 25, No. 6, 2014, p. 579-584.

Research output: Contribution to journalArticle

Mohanty, S, Santangeli, P, Mohanty, P, Di Biase, L, Trivedi, C, Bai, R, Horton, R, Burkhardt, JD, Sanchez, JE, Zagrodzky, J, Bailey, S, Gallinghouse, JG, Hranitzky, PM, Sun, AY, Hongo, R, Beheiry, S & Natale, A 2014, 'Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting', Journal of Cardiovascular Electrophysiology, vol. 25, no. 6, pp. 579-584. https://doi.org/10.1111/jce.12386
Mohanty, Sanghamitra ; Santangeli, Pasquale ; Mohanty, Prasant ; Di Biase, Luigi ; Trivedi, Chintan ; Bai, Rong ; Horton, Rodney ; Burkhardt, J. David ; Sanchez, Javier E. ; Zagrodzky, Jason ; Bailey, Shane ; Gallinghouse, Joseph G. ; Hranitzky, Patrick M. ; Sun, Albert Y. ; Hongo, Richard ; Beheiry, Salwa ; Natale, Andrea. / Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting. In: Journal of Cardiovascular Electrophysiology. 2014 ; Vol. 25, No. 6. pp. 579-584.
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abstract = "Management of Atrioesophageal Fistula Post-AF Ablation Introduction Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies. Methods Nine patients with AEF post-RFCA for AF were included in this study. AEF was diagnosed based on symptoms and chest CT imaging. Of the 9 patients, 5 received stents and 4 underwent surgical repair of fistula. Results AF ablation was performed under general anesthesia (n = 4) or conscious sedation (n = 5). During ablation, RF power was maintained between 25 and 35 Watts in areas close to the esophagus and energy delivery discontinued when esophageal temperature reached 38 °C. Seven patients underwent ablation with 3.5-mm open-irrigated catheter, 1 with 8-mm nonirrigated catheter, and 1 had surgical epicardial ablation. Seven patients received proton pump inhibitor and sucralfate before and after procedure. AEF symptoms developed within 2-6 weeks from ablation. Esophageal stenting was performed in 5 patients (median age 58 years, median time from RFCA 4 weeks) and 4 underwent surgical repair (median age 54 years, median time from RFCA 4 weeks) within 2-4 hours from diagnosis. All 5 patients receiving stents died within 1 week of the procedure due to cerebral embolism, septic shock, or respiratory failure. On the other hand, the 4 patients that received surgical repair were alive at median follow-up of 2.1 years (P = 0.005). Conclusions Esophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.",
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AU - Mohanty, Sanghamitra

AU - Santangeli, Pasquale

AU - Mohanty, Prasant

AU - Di Biase, Luigi

AU - Trivedi, Chintan

AU - Bai, Rong

AU - Horton, Rodney

AU - Burkhardt, J. David

AU - Sanchez, Javier E.

AU - Zagrodzky, Jason

AU - Bailey, Shane

AU - Gallinghouse, Joseph G.

AU - Hranitzky, Patrick M.

AU - Sun, Albert Y.

AU - Hongo, Richard

AU - Beheiry, Salwa

AU - Natale, Andrea

PY - 2014

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N2 - Management of Atrioesophageal Fistula Post-AF Ablation Introduction Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies. Methods Nine patients with AEF post-RFCA for AF were included in this study. AEF was diagnosed based on symptoms and chest CT imaging. Of the 9 patients, 5 received stents and 4 underwent surgical repair of fistula. Results AF ablation was performed under general anesthesia (n = 4) or conscious sedation (n = 5). During ablation, RF power was maintained between 25 and 35 Watts in areas close to the esophagus and energy delivery discontinued when esophageal temperature reached 38 °C. Seven patients underwent ablation with 3.5-mm open-irrigated catheter, 1 with 8-mm nonirrigated catheter, and 1 had surgical epicardial ablation. Seven patients received proton pump inhibitor and sucralfate before and after procedure. AEF symptoms developed within 2-6 weeks from ablation. Esophageal stenting was performed in 5 patients (median age 58 years, median time from RFCA 4 weeks) and 4 underwent surgical repair (median age 54 years, median time from RFCA 4 weeks) within 2-4 hours from diagnosis. All 5 patients receiving stents died within 1 week of the procedure due to cerebral embolism, septic shock, or respiratory failure. On the other hand, the 4 patients that received surgical repair were alive at median follow-up of 2.1 years (P = 0.005). Conclusions Esophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.

AB - Management of Atrioesophageal Fistula Post-AF Ablation Introduction Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies. Methods Nine patients with AEF post-RFCA for AF were included in this study. AEF was diagnosed based on symptoms and chest CT imaging. Of the 9 patients, 5 received stents and 4 underwent surgical repair of fistula. Results AF ablation was performed under general anesthesia (n = 4) or conscious sedation (n = 5). During ablation, RF power was maintained between 25 and 35 Watts in areas close to the esophagus and energy delivery discontinued when esophageal temperature reached 38 °C. Seven patients underwent ablation with 3.5-mm open-irrigated catheter, 1 with 8-mm nonirrigated catheter, and 1 had surgical epicardial ablation. Seven patients received proton pump inhibitor and sucralfate before and after procedure. AEF symptoms developed within 2-6 weeks from ablation. Esophageal stenting was performed in 5 patients (median age 58 years, median time from RFCA 4 weeks) and 4 underwent surgical repair (median age 54 years, median time from RFCA 4 weeks) within 2-4 hours from diagnosis. All 5 patients receiving stents died within 1 week of the procedure due to cerebral embolism, septic shock, or respiratory failure. On the other hand, the 4 patients that received surgical repair were alive at median follow-up of 2.1 years (P = 0.005). Conclusions Esophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.

KW - atrial fibrillation

KW - atrioesophageal fistul

KW - esophageal stent

KW - radiofrequency catheter ablation

KW - surgical repair of fistula

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