Atrial Esophageal Fistulas: A Case Series Demonstrating Three Distinct Operative Approaches with Favorable Outcomes.

Area of Science:

• Cardiology
• Gastroenterology
• Thoracic Surgery

Background:

• Atrial esophageal fistula (AEF) is a rare but serious complication following atrial ablation procedures.
• Optimal treatment strategies for AEF remain unclear due to its low incidence and high associated morbidity and mortality.

Purpose of the Study:

• To present the management strategies and outcomes of 4 patients diagnosed with AEF.
• To evaluate the effectiveness of different treatment approaches for AEF.

Main Methods:

• Retrospective chart review of 4 patients treated for AEF at a single tertiary care center between March 2020 and April 2024.
• Analysis of management strategies including surgical repair and combined endoscopic/percutaneous approaches.

Main Results:

• Three patients underwent surgical repair (right thoracotomy or median sternotomy with cardiopulmonary bypass followed by right thoracotomy) and are alive with good oral intake.
• One patient treated with endoscopic and percutaneous methods, despite initial recovery, experienced AEF progression and expired due to neurologic sequelae.
• The patient who did not survive had a considerably higher baseline surgical risk.

Conclusions:

• Surgical management, with or without cardiopulmonary bypass, demonstrated success in this case series for AEF.
• Endoscopic treatment, while documented, was not successful in this series.
• Surgical repair should be considered the preferred treatment for AEF in most patients, reserving other approaches for those with prohibitive surgical risks.