Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/18367
Title: Atrioesophageal Fistula: Clinical Presentation, Procedural Characteristics, Diagnostic Investigations, and Treatment Outcomes.
Authors: Han, Hui-Chen;Ha, Francis J;Sanders, Prashanthan;Spencer, Ryan J;Teh, Andrew W;O'Donnell, David;Farouque, Omar;Lim, Han S
Affiliation: Northern Health, Melbourne, Victoria, Australia
Austin Health, Heidelberg, Victoria, Australia
University of Melbourne, Victoria, Australia
Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital
Issue Date: Nov-2017
Citation: Circulation. Arrhythmia and electrophysiology 2017; 10(11): e005579
Abstract: Percutaneous or surgical ablation are increasingly used worldwide in the management of atrial fibrillation. The development of atrioesophageal fistula (AEF) is among the most serious and lethal complications of atrial fibrillation ablation. We sought to characterize the clinical presentation, procedural characteristics, diagnostic investigations, and treatment outcomes of all reported cases of AEF. Electronic searches were conducted in PubMed and Embase for English scientific literature articles. Out of 628 references, 120 cases of AEF were identified using various ablation modalities. Clinical presentation occurred between 0 and 60 days postablation (median 21 days). Fever (73%), neurological (72%), gastrointestinal (41%), and cardiac (40%) symptoms were the commonest presentations. Computed tomography of the chest was the commonest mode of diagnosis (68%), although 7 cases required repeat testing. Overall mortality was 55%, with significantly reduced mortality in patients undergoing surgical repair (33%) compared with endoscopic treatment (65%) and conservative management (97%) (adjusted odds ratio, 24.9; P<0.01, compared with surgery). Multivariable predictors of mortality include presentation with neurological symptoms (adjusted odds ratio, 16.0; P<0.001) and gastrointestinal bleed (adjusted odds ratio, 4.2; P=0.047). AEF complicating atrial fibrillation ablation is associated with a high mortality. Clinicians should have a high suspicion for the development of AEF in patients presenting with infective, neurological, gastrointestinal, or cardiac symptoms within 2 months of an atrial fibrillation ablation. Investigation by contrast computed tomography of the chest with consideration of repeat testing can lead to prompt diagnosis. Surgical intervention is associated with improved survival rates.
URI: http://ahro.austin.org.au/austinjspui/handle/1/18367
DOI: 10.1161/CIRCEP.117.005579
ORCID: 0000-0003-3206-5725
PubMed URL: 29109075
Type: Journal Article
Review
Subjects: atrial fibrillation
esophageal fistula
safety
survival rate
treatment outcome
Appears in Collections:Journal articles

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