1
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil and Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France and Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, USA
| | - Ngai-Yin Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Cardiac Electrophysiology and Stimulation Department, Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, and Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas and Case Western Reserve University, Cleveland, Ohio and Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, USA
| | - Kevin L Thomas
- Duke University Medical Center, Durham, North Carolina, USA
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Shah SK, Pendleton AC, Khan AA, Alex GC. Pericardioesophageal fistulae after left atrial ablation: a case series. J Surg Case Rep 2024; 2024:rjae160. [PMID: 38505335 PMCID: PMC10948743 DOI: 10.1093/jscr/rjae160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
Pericardioesophageal fistula is an uncommon, yet serious complication that can occur after left atrial ablation for cardiac arrhythmias. Timing of this complication is variable; however, it has been reported to occur from a week to over a month post-ablation. The incidence of this complication after ablation is <0.05%; however with increasing rates of left atrial ablations, early recognition is imperative. Nonspecific symptoms, including chest pain, dysphagia, and fever, can indicate the presence of a fistula within the first month after ablation. Early drainage with subsequent definitive treatment is key to limiting morbidity. Here we report four cases of pericardioesophageal fistula all occurring ~1 month post-ablation, with two patients surviving after prompt diagnosis and surgical treatment. Successful treatment in these two cases was achieved with fistula takedown and intercostal muscle flap interposition and esophageal stenting.
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Affiliation(s)
- Savan K Shah
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL 60605, USA
| | - Audrey C Pendleton
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL 60605, USA
| | - Arsalan A Khan
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL 60605, USA
| | - Gillian C Alex
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL 60605, USA
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Moiroux-Sahraoui A, Manceau G, Schoell T, Combes A, Bouglé A, Leprince P, Vaillant JC, Lebreton G. Atrio-oesophageal fistula following atrial fibrillation ablation: how to manage this dreaded complication? Interact Cardiovasc Thorac Surg 2021; 33:935-940. [PMID: 34313300 DOI: 10.1093/icvts/ivab202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Atrio-oesophageal fistula is a rare but serious complication of radiofrequency catheter ablation of atrial fibrillation. Therapeutic options are surgery, oesophageal stenting and conservative treatment (antibiotics and anticoagulation). However, there are no guidelines available. Since no article dwells on the technical considerations of this surgery, we aim to present here our experience and share our surgical approach. METHODS Between January 2012 and March 2020, all consecutive patients treated for atrio-oesophageal fistula following radiofrequency catheter ablation of atrial fibrillation at our institution were analysed retrospectively. The diagnosis was made on a set of clinical and radiological signs. All patients benefitted from a combined approach involving both digestive and cardiac surgeons. Femoro-femoral peripheral cardiopulmonary by-pass was used. The surgical approach was a right posterolateral thoracotomy. Atrial repair was done on fibrillating heart without cross-clamping, using a left atriotomy. Digestive management consisted of a total oesophagectomy. RESULTS We identified 6 patients with this complication. The median age was 53 [34-72] years. Symptoms were neurological symptoms, fever and chest pain. Diagnostic modalities were cerebral imaging, chest CT and transthoracic echocardiogram. Atrial repair consisted in a suture of the atrium or by using a pericardial patch. With a median follow-up of 3.1 [0.1-7.7] years, only one patient died during the follow-up. CONCLUSIONS Our experience shows that an aggressive surgery with a large resection of the oesophagus and left atrial repair by right thoracotomy in the same time provides good results. The ability to involve simultaneously both experienced digestive and cardiac surgical teams is the key for this strategy.
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Affiliation(s)
- Alexander Moiroux-Sahraoui
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital,Department of Cardiac Surgery, Paris, France
| | - Gilles Manceau
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital,Department of Digestive and Hepato-Pancreato-Biliary Surgery, Paris, France
| | - Thibaut Schoell
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital,Department of Cardiac Surgery, Paris, France
| | - Alain Combes
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical-Surgical Intensive Care Unit, Paris, France
| | - Adrien Bouglé
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Anesthesiology and Critical Care, Paris, France
| | - Pascal Leprince
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital,Department of Cardiac Surgery, Paris, France
| | - Jean Christophe Vaillant
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital,Department of Digestive and Hepato-Pancreato-Biliary Surgery, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital,Department of Cardiac Surgery, Paris, France
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6
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Bowman AW, DiSantis DJ, Frey RT. Esophagopericardial Fistula Causing Pyopneumopericardium. Radiol Cardiothorac Imaging 2020; 2:e200417. [PMID: 33778644 DOI: 10.1148/ryct.2020200417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/23/2020] [Accepted: 10/22/2020] [Indexed: 11/11/2022]
Abstract
An esophagopericardial fistula is a rare complication of esophageal malignancy, trauma, or surgery. Imaging is a cornerstone of diagnosis, with detection of pneumopericardium or hydropneumopericardium at imaging raising suspicion for pyopneumopericardium and prompting immediate search for the causative pathologic process. Given the high associated mortality rate of over 50% for patients with esophagopericardial fistulas, early diagnosis and intervention are vital. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Andrew W Bowman
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - David J DiSantis
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - R Terrell Frey
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224
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7
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Apte NM, Shrestha A, Dendi R. Techniques to Avoid Complications of Atrial Fibrillation Ablation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Back Sternick E, Soares Correa F, Ferber Drumond L, Albuquerque Carreiro R, Alves Rabelo M, Tarso Vaz de Oliveira P. Esophago‐pericardial fistula after catheter ablation of atrial fibrillation: A review. J Cardiovasc Electrophysiol 2020; 31:2600-2606. [DOI: 10.1111/jce.14723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Eduardo Back Sternick
- Electrophysiology Unit Biocor Instituto Nova Lima Minas Gerais Brazil
- Department of Cardiovascular Surgery, Electrophysiology Unit Biocor Instituto Nova Lima Minas Gerais Brazil
| | - Frederico Soares Correa
- Electrophysiology Unit Biocor Instituto Nova Lima Minas Gerais Brazil
- Department of Cardiovascular Surgery, Electrophysiology Unit Biocor Instituto Nova Lima Minas Gerais Brazil
| | - Leonardo Ferber Drumond
- Electrophysiology Unit Biocor Instituto Nova Lima Minas Gerais Brazil
- Department of Endoscopy and Cardiovascular Surgery Biocor Instituto Nova Lima Minas Gerais Brazil
| | - Rodrigo Albuquerque Carreiro
- Electrophysiology Unit Biocor Instituto Nova Lima Minas Gerais Brazil
- Department of Endoscopy Biocor Instituto Nova Lima Minas Gerais Brazil
| | - Manuela Alves Rabelo
- Electrophysiology Unit Biocor Instituto Nova Lima Minas Gerais Brazil
- Department of Digestive Tract Surgery Biocor Instituto Nova Lima Minas Gerais Brazil
| | - Paulo Tarso Vaz de Oliveira
- Electrophysiology Unit Biocor Instituto Nova Lima Minas Gerais Brazil
- Department of Digestive Tract Surgery Biocor Instituto Nova Lima Minas Gerais Brazil
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Commentary: Postablation atrial-esophageal fistula-the way to a man's heart? JTCVS Tech 2020; 4:176-177. [PMID: 34318003 PMCID: PMC8303051 DOI: 10.1016/j.xjtc.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 07/26/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022] Open
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Benhayon D, Wu F, Tarrazzi F, Cogan J, Castillo D, Levine J, Cortelli M, Block MI, Gongora E. Atrioesophageal fistula post atrial fibrillation ablation managed with an esophageal stent followed by surgical repair. HeartRhythm Case Rep 2020; 6:378-381. [PMID: 32695581 PMCID: PMC7360981 DOI: 10.1016/j.hrcr.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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11
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Siroky GP, Niazi K, Ghaly A, Kahaleh M, Tyberg A, Langenfeld J, Kostis WJ, Kassotis J, Coromilas J, Saluja D. Surgical and endoscopic management of a pericardioesophageal fistula after radiofrequency pulmonary vein isolation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1408-1411. [PMID: 32543768 DOI: 10.1111/pace.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/26/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The most feared complication of pulmonary vein isolation (PVI) is an atrioesophageal fistula (AEF). While rare (0.1-0.25%), primary surgical closure (as opposed to esophageal stenting) is associated with lower mortality. Pericardioesophageal fistula (PEF) may present prior to fistulization into the atrium. Unfortunately, data on the optimal management of PEFs are lacking. CASE REPORT Seventy-one-year-old male with AF presented with chest pain 3 weeks after radiofrequency PVI. Computed tomography angiography (CTA) chest and echocardiogram showed pneumopericardium. Barium esophagram showed extravasation from esophagus into the pericardium without connection to the left atrium. Sternotomy with mediastinal exploration exposed the pericardial defect, over which a CorMatrix patch was placed. The fistula was then stented endoscopically with endosuture fixation. Poststent esophagram did not show barium leak, and the patient was discharged home. One week later, the patient returned with enterococcal and candida bacteremia and an acute right parietal/occipital lobe infarct. Barium esophagram showed contrast extravasation into the pericardium. The patient rapidly succumbed to his illness and died. Autopsy revealed pericardial abscess posterior to the LA in communication with the esophagus. Extension to the LA was not seen. CONCLUSION While the surgical treatment of AEF is relatively well established, there is no consensus in the management of PEF. While prior small series have suggested PEF may be managed with esophageal stenting, our case illustrates the limitations of this approach.
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Affiliation(s)
- Gregory P Siroky
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kareem Niazi
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Aziz Ghaly
- Division of Cardiothoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michel Kahaleh
- Division of Gastroenterology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Amy Tyberg
- Division of Gastroenterology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - John Langenfeld
- Division of Thoracic Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - William J Kostis
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - John Kassotis
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - James Coromilas
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Deepak Saluja
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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12
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Bodziock GM, Norton CA, Montgomery JA. Prevention and Treatment of Atrioesophageal Fistula Related to Catheter Ablation for Atrial Fibrillation. J Innov Card Rhythm Manag 2020; 10:3634-3640. [PMID: 32477729 PMCID: PMC7252742 DOI: 10.19102/icrm.2019.100505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 11/22/2022] Open
Abstract
Atrioesophageal fistula (AEF) is an uncommon but devastating complication of catheter ablation for atrial fibrillation. Even with appropriate recognition and treatment, mortality is greater than 30% in most studies. If AEF is suspected, it is essential to avoid endoscopy and to order immediate cross-sectional imaging. If the diagnosis is confirmed, a thoracic surgeon should be promptly notified and must assess the patient urgently. The prognosis for AEF is poor even if it is appropriately recognized and addressed, so prevention must be a high priority. Prevention of AEF should involve the use of low-risk and cost-effective measures during ablation, which may increase safety, efficacy, or both. These strategies may include conscious sedation (as opposed to general anesthesia), low-power ablation, low-flow irrigation, short-duration lesions, esophageal temperature measurement, esophageal deviation, and pharmacologic prophylaxis with proton pump inhibitors or histamine H2 receptor blockers. Multiple new technologies are now becoming available, which may further reduce esophageal injury. Proceduralists should be aware of the available techniques and equipment that may help to reduce the risk of AEF, while simultaneously considering the possibility of unintended consequences.
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Affiliation(s)
- George M Bodziock
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Caleb A Norton
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jay A Montgomery
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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13
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Comprehensive review of pericardial diseases using different imaging modalities. Int J Cardiovasc Imaging 2020; 36:947-969. [DOI: 10.1007/s10554-020-01784-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022]
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14
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Wyn Davies D, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Interv Card Electrophysiol 2019; 50:1-55. [PMID: 28914401 PMCID: PMC5633646 DOI: 10.1007/s10840-017-0277-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | - Joseph G Akar
- Yale University School of Medicine, New Haven, CT, USA
| | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, UK
| | - Peng-Sheng Chen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, UK
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY, USA
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA, USA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, USA
- The National Center for Cardiovascular Research Carlos III (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO, USA
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Stanley Nattel
- Montreal Heart Institute, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
- McGill University, Montreal, QC, Canada
- University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
- Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, ON, Canada
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Siddiqi S, Schraufnagel DP, Siddiqui HU, Javorski MJ, Mace A, Elnaggar AS, Elgharably H, Vargo PR, Steffen R, Hasan SM, Raja S. Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae. Expert Rev Med Devices 2019; 16:197-209. [PMID: 30767693 DOI: 10.1080/17434440.2019.1582329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Historically, the gold standard management of esophageal perforations, leaks, and fistulae has been traditional open surgery, but it is associated with significant morbidity and mortality. Minimally invasive approaches offer alternatives to surgery in treating hemodynamically stable patients with such defects. In this review article, we will discuss the recent advancements in the minimally invasive management of esophageal perforations, leaks, and fistulas. AREAS COVERED This review includes information from case reports, case series, and clinical trials on minimally invasive management of esophageal perforations, leaks, and fistulas. The focus is on the devices, outcomes, and application of the technology. EXPERT COMMENTARY Minimally invasive treatment represents significant progress in the management of esophageal perforations, leaks, and fistulas. Based on current evidence, it seems safe and effective but it is evolving and more studies are needed to help draw definitive conclusions.
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Affiliation(s)
- Shirin Siddiqi
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Dean P Schraufnagel
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Hafiz Umair Siddiqui
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Michael J Javorski
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Adam Mace
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Abdulrhman S Elnaggar
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Haytham Elgharably
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Patrick R Vargo
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Robert Steffen
- b Department of Cardiovascular Surgery , Minneapolis Heart Institute Foundation , Minneapolis , MN , USA
| | - Saad M Hasan
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Siva Raja
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
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16
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Wu TC, Pisani C, Scanavacca MI. Approaches to the Diagnosis and Management of Atrial-Esophageal Fistula After Catheter Ablation for Atrial Arrhythmias. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0602-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Jehaludi A, Heist EK, Giveans MR, Anand R. Retrospective review of 65 atrioesophageal fistulas post atrial fibrillation ablation. Indian Pacing Electrophysiol J 2018; 18:100-107. [PMID: 29476903 PMCID: PMC5986301 DOI: 10.1016/j.ipej.2018.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/08/2018] [Indexed: 11/06/2022] Open
Abstract
Background Although a rare complication of catheter based ablation for atrial fibrillation (AF), atrioesophageal fistula (AEF) is a serious and fatal event [[1], [2], [3], [4], [5]]. Most reports of AEF are single cases or small case series. Objective The purpose of this study was to perform a comprehensive literature search of all published atrioesophageal fistula following catheter ablation for AF in order to identify the mortality rates associated with therapeutic modalities and suggest the most definitive management in reducing mortality. Methods A comprehensive literature review of reported observational cases of atrioesophageal fistula post catheter based ablation for atrial fibrillation was performed. Results Sixty-five cases of AEF post atrial fibrillation ablation were reviewed. The mean age was 55 years old. 73.8% (48/65) of the identified cases occurred in males (p < 0.001). Of the 65 cases, 13 underwent surgical radiofrequency ablation (RFA) and 52 underwent percutaneous RFA. Mortality resulted in 53.8% of those who underwent surgical RFA and in 55.8% of those who underwent percutaneous RFA (p = .888). The time range interval from procedure to onset of symptoms was 1–60 days. The most prevalent symptom, fever, occurred in 52 of the 65 cases, followed by neurological symptoms (n = 44). CT of the chest (n = 37), transthoracic echocardiogram (n = 21), and CT of the head (n = 18) were the preferred diagnostic modalities. Patients who underwent surgical correction with esophageal repair for treatment were more likely to survive, in comparison to patients who were treated with non-surgical interventions, such as antibiotic therapy, anticoagulation therapy or esophageal stenting. Of the total 34 patients who were treated surgically, 27 survived (79.4%). Of the total 31 patients who were treated non-surgically, only 2 survived (6.5%), reflecting significantly lower mortality with surgical versus non-surgical therapy (p < 0.001). Conclusion Atrioesophageal fistula is an uncommon but potentially fatal complication of atrial fibrillation ablation. Patients who underwent surgical repair were twelve times more likely to survive than those treated with stenting, antibiotic therapy or no intervention. Based on the observation that patients are 12 times more likely to survive an AEF with surgery than without, the authors believe that prompt surgical correction of AEF should be considered as standard of care when dealing with this dreaded complication.
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Affiliation(s)
- Ameena Jehaludi
- Electrophysiology Deptartment, Holy Cross Hospital, Fort Lauderdale, FL, USA
| | - E Kevin Heist
- Electrophysiology Deptartment, Massachusetts General Hospital, Boston, MA, USA
| | - M Russell Giveans
- Electrophysiology Deptartment, Holy Cross Hospital, Fort Lauderdale, FL, USA
| | - Rishi Anand
- Electrophysiology Deptartment, Holy Cross Hospital, Fort Lauderdale, FL, USA.
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18
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot NMS(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace 2018; 20:157-208. [PMID: 29016841 PMCID: PMC5892164 DOI: 10.1093/europace/eux275] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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19
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 681] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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20
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Canpolat U, Kocyigit D, Aytemir K. Complications of Atrial Fibrillation Cryoablation. J Atr Fibrillation 2017; 10:1620. [PMID: 29487676 PMCID: PMC5821627 DOI: 10.4022/jafib.1620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/19/2017] [Accepted: 10/14/2017] [Indexed: 12/18/2022]
Abstract
Catheter ablation either by using radiofrequency or cryo energy in symptomatic patients with atrial fibrillation (AF) has shown to be effective as compared to anti-arrhythmic drugs. However, all the techniques used during AF ablation are not free of complication. There are several well-known peri-procedural complications in which operators should be informed of the possible risks, cautious during the procedure and able to manage them when occurred. Herein, we aimed to review possible complications of AF cryoablation.
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Affiliation(s)
- Ugur Canpolat
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Duygu Kocyigit
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Kudret Aytemir
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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21
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Khakpour H, Shemin RJ, Lee JM, Buch E, Boyle NG, Shivkumar K, Bradfield JS. Atrioesophageal Fistula After Atrial Fibrillation Ablation: A single center series. J Atr Fibrillation 2017; 10:1654. [PMID: 29250244 DOI: 10.4022/jafib.1654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/19/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022]
Abstract
Background The incidence of atrioesophageal fistula (AEF) after atrial fibrillation catheter ablation is reported to be 0.015%-0.04%, though it is likely underreported due to a number of factors including misdiagnosis. We report our institutional experience with AEF. Methods Patients with confirmed diagnosis of AEF between 2004 and 2016 at our institution were identified (n=5) and their clinical characteristics and outcome were analyzed. Results AEF occurred in 5 patients who underwent AF catheter ablation (3 ablated at our institution; 2 transferred from outside hospitals after diagnosis of AEF). Symptoms were chest pain (n=3), fever (n=3), TIA/stroke (n=3), dysphagia (n=1), and headache (n=1). Chest pain was the earliest symptom and occurred 21-24 days post-RFA. One patient had sudden death without preceding symptoms. Findings included leukocytosis (WBC count range of 17200-19,000) and sepsis. Chest CT was obtained in 3 patients and showed air in the left atrium or mediastinum. Three patients had evidence of multifocal stroke on MRI. Three patients died before surgery could be performed. Two patients (40%) underwent emergent surgery which included partial excision of atrial wall, closure with bovine pericardial patch and closure of esophageal lesion. Surgical outcomes were favorable (100% survival). Conclusion Chest pain and fever were the early symptoms of AEF and occurred before the neurologic complications. Chest CT was an excellent tool for detection of AEF. All patients who were diagnosed correctly and underwent surgery survived. Early detection is imperative as prompt surgery may improve survival. Health-care community education is the key to ensure early detection and transfer to a qualified surgical center.
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Affiliation(s)
- Houman Khakpour
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Richard J Shemin
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jay M Lee
- Division of Thoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA
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22
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Abstract
Atrial fibrillation (AF) remains a difficult management problem. The restoration and maintenance of sinus rhythm-rhythm control therapy-can markedly improve symptoms and haemodynamics for patients who have paroxysmal or persistent AF, but some patients fare well with rate control alone. Sinus rhythm can be achieved with anti-arrhythmic drugs or electrical cardioversion, but the maintenance of sinus rhythm without recurrence is more challenging. Catheter ablation of the AF triggers is more effective than anti-arrhythmic drugs at maintaining sinus rhythm. Whilst pulmonary vein isolation is an effective strategy, other ablation targets are being evaluated to improve sinus rhythm maintenance, especially in patients with chronic forms of AF. Previously extensive ablation strategies have been used for patients with persistent AF, but a recent trial has shown that pulmonary vein isolation without additional ablation lesions is associated with outcomes similar to those of more extensive ablation. This has led to an increase in catheter-based technology to achieve durable pulmonary vein isolation. Furthermore, a combination of anti-arrhythmic drugs and catheter ablation seems useful to improve the effectiveness of rhythm control therapy. Two large ongoing trials evaluate whether a modern rhythm control therapy can improve prognosis in patients with AF.
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Affiliation(s)
- Richard Bond
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Paulus Kirchhof
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
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23
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2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Heart Rhythm 2017; 14:e445-e494. [DOI: 10.1016/j.hrthm.2017.07.009] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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24
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1293] [Impact Index Per Article: 184.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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25
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Kapur S, Barbhaiya C, Deneke T, Michaud GF. Esophageal Injury and Atrioesophageal Fistula Caused by Ablation for Atrial Fibrillation. Circulation 2017; 136:1247-1255. [DOI: 10.1161/circulationaha.117.025827] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sunil Kapur
- From Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (S.K.); Division of Cardiology, New York University Langone Medical Center, New York (C.B.); Heart Center Bad Neustadt, Germany (T.D.); and Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (G.M.)
| | - Chirag Barbhaiya
- From Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (S.K.); Division of Cardiology, New York University Langone Medical Center, New York (C.B.); Heart Center Bad Neustadt, Germany (T.D.); and Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (G.M.)
| | - Thomas Deneke
- From Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (S.K.); Division of Cardiology, New York University Langone Medical Center, New York (C.B.); Heart Center Bad Neustadt, Germany (T.D.); and Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (G.M.)
| | - Gregory F. Michaud
- From Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (S.K.); Division of Cardiology, New York University Langone Medical Center, New York (C.B.); Heart Center Bad Neustadt, Germany (T.D.); and Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN (G.M.)
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26
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. J Arrhythm 2017; 33:369-409. [PMID: 29021841 PMCID: PMC5634725 DOI: 10.1016/j.joa.2017.08.001] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Key Words
- AAD, antiarrhythmic drug
- AF, atrial fibrillation
- AFL, atrial flutter
- Ablation
- Anticoagulation
- Arrhythmia
- Atrial fibrillation
- Atrial flutter
- Atrial tachycardia
- CB, cryoballoon
- CFAE, complex fractionated atrial electrogram
- Catheter ablation
- LA, left atrial
- LAA, left atrial appendage
- LGE, late gadolinium-enhanced
- LOE, level of evidence
- MRI, magnetic resonance imaging
- OAC, oral anticoagulation
- RF, radiofrequency
- Stroke
- Surgical ablation
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Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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27
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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28
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Al-Alao B, Pickens A, Lattouf O. Atrio-oesophageal fistula: dismal outcome of a rare complication with no common solution. Interact Cardiovasc Thorac Surg 2016; 23:949-956. [PMID: 27481684 DOI: 10.1093/icvts/ivw233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/01/2016] [Accepted: 06/09/2016] [Indexed: 11/14/2022] Open
Abstract
Atrio-oesophageal fistula caused by diffusion of ablative energy through the left atrial wall to the oesophagus is a lethal complication. A high level of suspicion, rapid diagnosis and early correction are of crucial importance. In this review, we highlight the key points that will aid in the thought processes and provide guidance in the prevention, early diagnosis and management to reduce complications and improve outcome when atrio-oesophageal fistula is suspected.
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Affiliation(s)
- Bassel Al-Alao
- Department of Cardiothoracic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Allen Pickens
- Department of Cardiothoracic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Omar Lattouf
- Department of Cardiothoracic Surgery, Emory University Hospital, Atlanta, GA, USA
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29
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Barbhaiya CR, Kumar S, Guo Y, Zhong J, John RM, Tedrow UB, Koplan BA, Epstein LM, Stevenson WG, Michaud GF. Global Survey of Esophageal Injury in Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2016; 2:143-150. [DOI: 10.1016/j.jacep.2015.10.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/01/2015] [Accepted: 10/22/2015] [Indexed: 12/20/2022]
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30
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Nair KKM, Danon A, Valaparambil A, Koruth JS, Singh SM. Atrioesophageal Fistula: A Review. J Atr Fibrillation 2015; 8:1331. [PMID: 27957213 DOI: 10.4022/jafib.1331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/09/2015] [Accepted: 10/13/2015] [Indexed: 12/30/2022]
Abstract
Catheter ablation of atrial ablation (AF) has become an important therapy in recent years. As with all evolving techniques, unexpected complication may occur. Atrioesophageal fistula is a very rare complication of AF catheter ablation. Described for the first time in two very experienced centers in 2004, this complication is the most dreadful and lethal among all the others related to AF catheter ablation. Its clinical presentation is extremely variable. Rapid diagnosis and surgical therapy may prevent death. This review article will summarize the risk factors, diagnosis, treatment and possible preventive strategies for this condition.
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Affiliation(s)
- Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Asaf Danon
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Jacob S Koruth
- Helmsley Cardiac Arrhythmia Service - Mount Sinai Medical Center, Mount Sinai School of Medicine, New York, NY, USA
| | - Sheldon M Singh
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario Canada
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31
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GÜNEŞ MAHMUTFATIH, GÖKOĞLAN YALÇIN, DI BIASE LUIGI, GIANNI CAROLA, MOHANTY SANGHAMITRA, HORTON RODNEY, BAILEY SHANE, NATALE ANDREA. Ablating the Posterior Heart: Cardioesophageal Fistula Complicating Radiofrequency Ablation in the Coronary Sinus. J Cardiovasc Electrophysiol 2015; 26:1376-8. [DOI: 10.1111/jce.12831] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/10/2015] [Accepted: 08/25/2015] [Indexed: 12/01/2022]
Affiliation(s)
- MAHMUT FATIH GÜNEŞ
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - YALÇIN GÖKOĞLAN
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - LUIGI DI BIASE
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York USA
- Department of Biomedical Engineering; University of Texas; Austin Texas USA
- Department of Clinical and Experimental Medicine; University of Foggia; Foggia Italy
| | - CAROLA GIANNI
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - SANGHAMITRA MOHANTY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - RODNEY HORTON
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Department of Biomedical Engineering; University of Texas; Austin Texas USA
| | - SHANE BAILEY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - ANDREA NATALE
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York USA
- Department of Biomedical Engineering; University of Texas; Austin Texas USA
- MetroHealth Medical Center; Case Western Reserve University School of Medicine; Cleveland Ohio USA
- Division of Cardiology; Stanford University School of Medicine; Stanford California USA. Electrophysiology and Arrhythmia Services; California Pacific Medical Center; San Francisco California USA. Interventional Electrophysiology; Scripps Clinic; La Jolla California USA. Dell Medical School; University of Texas; Austin Texas USA
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32
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Chavez P, Messerli FH, Casso Dominguez A, Aziz EF, Sichrovsky T, Garcia D, Barrett CD, Danik S. Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports. Open Heart 2015; 2:e000257. [PMID: 26380098 PMCID: PMC4567782 DOI: 10.1136/openhrt-2015-000257] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/12/2015] [Accepted: 06/02/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Atrioesophageal fistula (AEF) is a rare but serious adverse event of atrial fibrillation (AF) ablation. OBJECTIVE To identify the clinical characteristics of AEF following ablation procedures for AF and determine the associated mortality. METHODS A systematic review of observational cases of AEF following ablation procedures for AF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. RESULTS 53 cases were identified. Mean age was 54±13 years; 73% (39/53) of cases occurred in males. Mean interval between procedure and presentation was 20±12 days, ranging from 2 to 60 days. AEF was observed in 12 patients who underwent surgical radiofrequency ablation (RFA) and in 41 patients with percutaneous RFA. Fever was the most common presenting symptom (n=44) followed by neurological deficits (n=27) and haematemesis (n=19). CT of the chest (n=27) was the preferred diagnostic test. Patients who did not receive a primary esophageal repair were more likely to have a deadly outcome (34% vs 83%; p<0.05). No difference in mortality rate was found between patients who underwent surgical RFA when compared with percutaneous RFA (58% vs 56%; p=0.579). No association was found between onset of symptoms and mortality (19±10 vs 23±14 days; p=0.355). CONCLUSIONS AEF following ablation procedures for AF is a serious complication with high mortality rates. Presenting symptoms most often include a triad of fever, neurological deficit and/or haematemesis within 60 days of procedure. The preferred diagnostic test is CT of the chest. The treatments of choice is surgical repair.
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Affiliation(s)
- Patricia Chavez
- Division of Cardiology , St Luke's-Roosevelt Hospital Center, Mount Sinai Healthcare System , New York, New York , USA
| | - Franz H Messerli
- Division of Cardiology , St Luke's-Roosevelt Hospital Center, Mount Sinai Healthcare System , New York, New York , USA
| | - Abel Casso Dominguez
- Division of Cardiology , St Luke's-Roosevelt Hospital Center, Mount Sinai Healthcare System , New York, New York , USA
| | - Emad F Aziz
- Division of Cardiology , St Luke's-Roosevelt Hospital Center, Mount Sinai Healthcare System , New York, New York , USA
| | - Tina Sichrovsky
- Division of Cardiology , St Luke's-Roosevelt Hospital Center, Mount Sinai Healthcare System , New York, New York , USA
| | - Daniel Garcia
- University of Miami Hospital, University of Miami , Miami, Florida , USA
| | - Connor D Barrett
- Division of Cardiology , St Luke's-Roosevelt Hospital Center, Mount Sinai Healthcare System , New York, New York , USA
| | - Stephan Danik
- Division of Cardiology , St Luke's-Roosevelt Hospital Center, Mount Sinai Healthcare System , New York, New York , USA
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33
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Barbhaiya CR, Kumar S, John RM, Tedrow UB, Koplan BA, Epstein LM, Stevenson WG, Michaud GF. Global Survey of Esophageal and Gastric Injury in Atrial Fibrillation Ablation. J Am Coll Cardiol 2015; 65:1377-1378. [DOI: 10.1016/j.jacc.2014.12.053] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/01/2014] [Accepted: 12/16/2014] [Indexed: 11/30/2022]
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34
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Ren J, Callans DJ, Marchlinski FE, Stiffler JA, Sadek MM, Supple GE. 3D Intracardiac Echocardiography/CartoSound™ Imaging of Esophagus Guided Left Atrial Posterior Wall Ablation for Atrial Fibrillation. J Atr Fibrillation 2014; 7:1184. [PMID: 27957142 DOI: 10.4022/jafib.1184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 12/21/2014] [Accepted: 12/31/2014] [Indexed: 12/19/2022]
Abstract
Two imaging cases highlight the important role of 3D ICE/Cartosound™ in the intracardiac echocardiographic imaging of esophagus and Cartosound™ guidance of radiofrequency lesions delivered safely at the left atrial posterior wall adjacent to esophagus during atrial fibrillation ablation.
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Affiliation(s)
- JianFang Ren
- Cardiac Electrophysiology Laboratory Division of Cardiovascular Medicine University of Pennsylvania Health System Philadelphia, PA
| | - David J Callans
- Cardiac Electrophysiology Laboratory Division of Cardiovascular Medicine University of Pennsylvania Health System Philadelphia, PA
| | - Francis E Marchlinski
- Cardiac Electrophysiology Laboratory Division of Cardiovascular Medicine University of Pennsylvania Health System Philadelphia, PA
| | - Jeffrey A Stiffler
- Cardiac Electrophysiology Laboratory Division of Cardiovascular Medicine University of Pennsylvania Health System Philadelphia, PA
| | - Mouhannad M Sadek
- Cardiac Electrophysiology Laboratory Division of Cardiovascular Medicine University of Pennsylvania Health System Philadelphia, PA
| | - Gregory E Supple
- Cardiac Electrophysiology Laboratory Division of Cardiovascular Medicine University of Pennsylvania Health System Philadelphia, PA
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35
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Koa-Wing M, Jamil-Copley S, Ariff B, Kojodjojo P, Lim PB, Whinnett Z, Rajakulendran S, Malhotra P, Lefroy D, Peters NS, Davies DW, Kanagaratnam P. Haemorrhagic cerebral air embolism from an atrio-oesophageal fistula following atrial fibrillation ablation. Perfusion 2014; 30:484-6. [PMID: 25475690 DOI: 10.1177/0267659114562102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report the case of a man found unconscious three weeks following atrial fibrillation (AF) ablation. Cranial and thoracic imaging demonstrated multiple areas of pneumo-embolic infarction secondary to an atrio-oesophageal fistula (AEF). AEF is a recognised, but rare, complication of AF ablation.(1-8) Early recognition is critical as the mortality is 100% without surgical intervention. We consider the postulated mechanisms of AEF formation, the spectrum of clinical presentation, investigations and treatment.
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Affiliation(s)
- M Koa-Wing
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - S Jamil-Copley
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - B Ariff
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P Kojodjojo
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P B Lim
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Z Whinnett
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - S Rajakulendran
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P Malhotra
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - D Lefroy
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - N S Peters
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - D W Davies
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - P Kanagaratnam
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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36
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Complications from Catheter Ablation of Atrial Fibrillation: Impact of Current and Emerging Ablation Technologies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:344. [DOI: 10.1007/s11936-014-0344-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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37
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Loo SY, Sundararajan K. Fatal Atrial Oesophageal Fistula following Pulmonary Vein Isolation: An Unresolved Safety Issue. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation is a common cardiac arrhythmia that is associated with high morbidity and mortality. Radiofrequency ablation with extensive circumferential pulmonary vein isolation has been recognised as the most commonly employed ablation method to treat recurrent atrial fibrillation that is refractory to drug therapy. Atrial-oesophageal fistula is one of the most devastating complications following this procedure and has implications for intensive care clinicians. We report the clinical course of a patient with an extensive history of recurrent, drug-refractory atrial fibrillation who developed atrial-oesophageal fistula three weeks after pulmonary vein isolation, suffered a series of complications as a consequence, and eventually died.
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38
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Manouchehri N, Turner SR, Lockwood E, Sterns LD, Bédard EL. Esophageal perforation after radiofrequency ablation for atrial fibrillation. Asian Cardiovasc Thorac Ann 2014; 22:1116-8. [PMID: 24887888 DOI: 10.1177/0218492313504767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 69-year-old man underwent left atrial radiofrequency ablation for atrial fibrillation. After 10 minutes, the procedure was terminated due to pericardial tamponade secondary to perforation during mapping. Pericardiocentesis resolved the tamponade. Ablation was completed one week later, and the patient was discharged. Two days later, he presented with odynophagia. Computed tomography demonstrated small bilateral pleural effusions. He was judged to be stable and was discharged again, but returned 2 days later with chest pain. He was found to have esophageal perforation with empyema, which was repaired using a muscle patch and esophageal stenting, successfully treating the lesion with minimal morbidity.
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Affiliation(s)
- Namdar Manouchehri
- Department of Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, Canada
| | - Simon R Turner
- Department of Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, Canada
| | - Evan Lockwood
- Department of Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, Canada
| | | | - Eric Lr Bédard
- Department of Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, Canada
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39
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MOHANTY SANGHAMITRA, SANTANGELI PASQUALE, MOHANTY PRASANT, BIASE LUIGIDI, TRIVEDI CHINTAN, BAI RONG, HORTON RODNEY, BURKHARDT JDAVID, SANCHEZ JAVIERE, ZAGRODZKY JASON, BAILEY SHANE, GALLINGHOUSE JOSEPHG, HRANITZKY PATRICKM, SUN ALBERTY, HONGO RICHARD, BEHEIRY SALWA, NATALE ANDREA. Outcomes of Atrioesophageal Fistula Following Catheter Ablation of Atrial Fibrillation Treated with Surgical Repair versus Esophageal Stenting. J Cardiovasc Electrophysiol 2014; 25:579-84. [DOI: 10.1111/jce.12386] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- SANGHAMITRA MOHANTY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- College of Natural Sciences; University of Texas at Austin; Texas USA
| | - PASQUALE SANTANGELI
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Department of Cardiology; University of Foggia; Foggia Italy
| | - PRASANT MOHANTY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - LUIGI DI BIASE
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Department of Cardiology; University of Foggia; Foggia Italy
- Department of Biomedical Engineering; University of Texas at Austin; Texas USA
- Albert Einstein College of Medicine at Montefiore Hospital; Bronx New York USA
| | - CHINTAN TRIVEDI
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - RONG BAI
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - RODNEY HORTON
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - J. DAVID BURKHARDT
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - JAVIER E. SANCHEZ
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - JASON ZAGRODZKY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - SHANE BAILEY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | | | - PATRICK M. HRANITZKY
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | | | - RICHARD HONGO
- California Pacific Medical Center; San Francisco California USA
| | - SALWA BEHEIRY
- California Pacific Medical Center; San Francisco California USA
| | - ANDREA NATALE
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Department of Biomedical Engineering; University of Texas at Austin; Texas USA
- California Pacific Medical Center; San Francisco California USA
- Division of Cardiology; Stanford University; Palo Alto California USA
- Interventional Electrophysiology; Scripps Clinic; San Diego California USA. Case Western Reserve University; Cleveland Ohio USA
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40
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Neurologic complications of catheter ablation/defibrillators/pacemakers. HANDBOOK OF CLINICAL NEUROLOGY 2013. [PMID: 24365294 DOI: 10.1016/b978-0-7020-4086-3.00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Approaches to the management of patients with cardiac arrhythmias have significantly evolved over the last decade, with advancement in catheter ablation and device implantation techniques. As the techniques and tools evolve, so does our understanding of the possible complications from these procedures. The focus of this chapter is discussion of the neurologic complications involved with catheter ablation, pacemaker and defibrillation implantation, with the focus on timely diagnosis, and management strategies.
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41
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Singh SM, d’Avila A, Singh SK, Stelzer P, Saad EB, Skanes A, Aryana A, Chinitz JS, Kulina R, Miller MA, Reddy VY. Clinical outcomes after repair of left atrial esophageal fistulas occurring after atrial fibrillation ablation procedures. Heart Rhythm 2013; 10:1591-7. [DOI: 10.1016/j.hrthm.2013.08.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Indexed: 10/26/2022]
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42
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Pappone C, Vicedomini G, Santinelli V. Atrio-Esophageal Fistula After AF Ablation: Pathophysiology, Prevention &Treatment. J Atr Fibrillation 2013; 6:860. [PMID: 28496888 DOI: 10.4022/jafib.860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 11/10/2022]
Abstract
Atrioesophageal fistula is an extremely rare but often fatal late complication of atrial fibrillation ablation procedures resulting from massive thermal injury to the esophagus and surrounding structures. Causes of death include cerebral air embolism, massive gastrointestinal bleeding, and septic shock. Because of its exceptionally low rate of occurrence, no predictors of lesion development have been found and there has not been an uniform approach to either early diagnosis or corrective therapy. Currently, preventive strategies include empirically reducing power titration during PVI and/or while ablating the posterior left atrial wall, limiting energy delivery time and number, avoiding overlapping ablation lines as well as monitoring intraluminal esophageal temperature. In addition, it has been suggested to use conscious sedation rather than general anesthesia for better pain perception, monitoring intraprocedural esophageal position in relation to the posterior left atrium and extensive patient education regarding signs and symptoms of esophageal injury. Early diagnosis is essential to enable an aggressive treatment including stenting and/or surgical intervention to minimize the excessive morbidity and mortality associated with this condition. Unfortunately, despite application of such preventive measures, cases of complete atrial-esophageal fistula have still been reported.
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Affiliation(s)
- Carlo Pappone
- GVM Research and Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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43
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Successful non-operative management of left atrioesophageal fistula following catheter ablation. Surg Today 2013; 44:1565-8. [DOI: 10.1007/s00595-013-0744-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
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44
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Eitel C, Rolf S, Zachäus M, John S, Sommer P, Bollmann A, Arya A, Piorkowski C, Hindricks G, Halm U. Successful Nonsurgical Treatment of Esophagopericardial Fistulas After Atrial Fibrillation Catheter Ablation. Circ Arrhythm Electrophysiol 2013; 6:675-81. [DOI: 10.1161/circep.113.000384] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Charlotte Eitel
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Sascha Rolf
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Markus Zachäus
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Silke John
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Philipp Sommer
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Andreas Bollmann
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Arash Arya
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Christopher Piorkowski
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Gerhard Hindricks
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
| | - Ulrich Halm
- From the Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany (C.E., S.R., S.J., P.S., A.B., A.A., C.P., G.H.); and Department of Internal Medicine II, Park-Hospital Leipzig, Leipzig, Germany (M.Z., U.H.)
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45
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Shim HB, Kim C, Kim HK, Sung K. Successful management of atrio-esophageal fistula after cardiac radiofrequency catheter ablation. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:142-5. [PMID: 23614102 PMCID: PMC3631790 DOI: 10.5090/kjtcs.2013.46.2.142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/13/2012] [Accepted: 10/17/2012] [Indexed: 11/24/2022]
Abstract
An increase in cardiac radiofrequency catheter ablation for treating refractory atrial fibrillation has resulted in an increased prevalence of complications. Among numerous complications of radiofrequency catheter ablation, atrio-esophageal fistula, although rare, is known to have fatal results. We report a case of successful management of an atrio-esophageal fistula as a complication of cardiac radiofrequency catheter ablation.
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Affiliation(s)
- Hun Bo Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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46
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Wongcharoen W, Lo LW, Chen SA. Collateral Damage from Catheter Ablation of Atrial Fibrillation Lessons Learnt in the Past Decade. J Atr Fibrillation 2013; 5:831. [PMID: 28496837 DOI: 10.4022/jafib.831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 03/11/2013] [Accepted: 03/21/2013] [Indexed: 11/10/2022]
Abstract
Catheter ablation for atrial fibrillation (AF) has been increasingly performed over the past decade. Regardless of technological advances and technique improvement, catheter ablation for AF remains a highly complex procedure and the risk of procedural complications is not negligible. This article discusses the management and the approach to avoid the serious complications of catheter AF ablation including pulmonary vein stenosis, atrioesophageal fistula, cardiac tamponade, stroke and collateral nervous damage. The management of periprocedural anticoagulation and the complications associated with epicardial AF ablation are also described.
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Affiliation(s)
- Wanwarang Wongcharoen
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; and the Institute of Clinical Medicine and Cardiovascular Research, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; and the Institute of Clinical Medicine and Cardiovascular Research, National Yang-Ming University, Taipei, Taiwan
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47
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Raviele A, Natale A, Calkins H, Camm JA, Cappato R, Ann Chen S, Connolly SJ, Damiano R, DE Ponti R, Edgerton JR, Haïssaguerre M, Hindricks G, Ho SY, Jalife J, Kirchhof P, Kottkamp H, Kuck KH, Marchlinski FE, Packer DL, Pappone C, Prystowsky E, Reddy VK, Themistoclakis S, Verma A, Wilber DJ, Willems S. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J Cardiovasc Electrophysiol 2013; 23:890-923. [PMID: 22953789 DOI: 10.1111/j.1540-8167.2012.02381.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Raviele
- Cardiovascular Department, Arrhythmia Center and Center for Atrial Fibrillation, Dell'Angelo Hospital, Venice-Mestre, Italy.
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48
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Podgaetz E, Deschamps C. Esophageal complications of catheter ablation for atrial fibrillation: A case report. J Thorac Cardiovasc Surg 2013; 145:e9-13. [DOI: 10.1016/j.jtcvs.2012.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/15/2012] [Indexed: 11/28/2022]
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49
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Hartman AR, Glassman L, Katz S, Chinitz L, Ross W. Surgical Repair of a Left Atrial-Esophageal Fistula After Radiofrequency Catheter Ablation for Atrial Fibrillation. Ann Thorac Surg 2012; 94:e91-3. [DOI: 10.1016/j.athoracsur.2012.04.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 03/18/2012] [Accepted: 04/02/2012] [Indexed: 11/28/2022]
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50
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2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
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