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Atrioesophageal fistula post atrial fibrillation ablation: A multicenter study from China
Chang-Yi Li1, Song-Nan Li1, Chen-Yang Jiang2
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Atrioesophageal fistula (AEF) is a rare complication after atrial fibrillation (AF) ablation. Early diagnosis and surgical repair significantly improve survival rates for AEF patients.
Area of Science:
- Cardiology
- Medical Complications
- Surgical Outcomes
Background:
- Atrioesophageal fistula (AEF) is a rare, high-mortality complication following atrial fibrillation (AF) ablation.
- This study investigates the epidemiology, clinical features, pathogenesis, and management of AEF post-AF ablation.
Discussion:
- AEF presents with diverse symptoms, including fever, neurological deficits, chest pain, and hematemesis.
- The incidence of AEF following left atrial ablation was found to be 0.035% in this cohort.
- Symptoms typically manifest within 18.3 days post-procedure.
Key Insights:
- Surgical repair was associated with a better prognosis (50% survival) compared to non-surgical management (100% mortality).
- The overall mortality rate for AEF in this study was 75.0%.
Outlook:
- Early diagnosis and prompt surgical intervention are crucial for improving survival in AEF patients.
- Further research may focus on preventative strategies and refining surgical techniques for AEF management.
Background And Objective:
Atrioesophageal fistula (AEF) is a rare but devastating complication with high mortality post atrial fibrillation (AF) ablation. The purpose of current study was to determine the epidemiology, clinical features, pathogenesis, and management of AEF after AF ablation.
Methods And Results:
Patients with diagnosed AEF were included and retrospectively analyzed according to the registry of 11 centers in China from January 2010 to December 2019. A total of 16 AEF cases were identified from 44 794 patients who received a left atrial ablation procedure (0.035% per procedure). The interval from procedure to clinical onset of AEF averaged 18.3 days (3-39 days). The fever ranked the most common symptom, occurred in 14 of the 16 cases, followed by neurological deficits (n = 11), chest pain (n = 5), and hematemesis (n = 4). Patients undergoing surgical repair had a better prognosis compared to those receiving nonsurgical management ([4 of 8] 50.0% vs [8 of 8] 100%, P < .05) with an overall mortality rate of 75.0%.
Conclusion:
AEF is highly characterized by varied manifestations. Early diagnosis and urgent surgical repair are vital to those patients and associated with improved survival rates.
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