Approaches to the Diagnosis and Management of Atrial-Esophageal Fistula After Catheter Ablation for Atrial Arrhythmias
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ARRHYTHMIAS (J. BUNCH, SECTION EDITOR)
Approaches to the Diagnosis and Management of Atrial-Esophageal Fistula After Catheter Ablation for Atrial Arrhythmias Tan Chen Wu 1 & Cristiano Pisani 1 & Maurício I. Scanavacca 1
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose of Review Catheter ablation has become a cornerstone of therapy in the management of patients with atrial fibrillation (AF). Thermal energy generated in the left atrium (LA) during ablation has the potential to damage adjacent structures. The most feared and rare complication in these ablations is atrial-esophageal fistula (AEF) result from the thermal injury to the esophagus due to the proximity to the LA, with potential catastrophic outcome. This review focuses on the diagnosis and management of AEF after catheter ablation for AF, including preventive measures to avoid esophageal lesions. Recent Findings Symptoms of AEF are often vague and nonspecific, sometimes asymptomatic until they present with fistula or perforation, making the diagnosis somewhat challenging. The esophagogastroduodenoscopy is the gold standard for early detection of esophageal lesions related to AF ablation. Chest CT with oral and intravenous contrast is preferred when there is suspicion of perforation. The use of an esophageal temperature probe during ablation to monitoring esophageal temperature, associated with mechanical displacement of the esophagus, may be feasible to prevent thermal esophageal lesions and enabling adequate energy delivery to the posterior wall of the LA. Prophylactic use of proton pump inhibitors after AF ablation is accepted to be effective and justified as preventive treatment. Summary AEF is an unpredictable complication. Be aware of these complications in the follow-up of patients after AF ablation can lead to the early recognition to start treatment, including surgical repair, as soon as possible to prevent the fatal outcome. Keywords Atrial fibrillation . Catheter ablation . Pulmonary vein isolation . Esophageal injury . Atrial-esophageal fistula
Abbreviations AEF Atrial-esophageal fistula AF Atrial fibrillation CT Computer tomography EGD Esophagogastroduodenoscopy LA Left atrium MR Magnetic resonance NPO Nir per os PPIs Proton pump inhibitors PV Pulmonary vein RF Radiofrequency This article is part of the Topical Collection on Arrhythmias * Tan Chen Wu [email protected] 1
Arrhythmia Unit, Heart Institute, University of São Paulo Medical School, Av Dr. Eneas Carvalho de Aguiar 44, São Paulo, SP CEP 05403-000, Brazil
Introduction Atrial fibrillation (AF) is the most prevalent arrhythmia and the treatment by catheter ablation has become a cornerstone of therapy in the management of patients with AF. Since Haïssaguerre and coworkers described the role of pulmonary veins, the increasing operator experience and the advances in technology over the past decade have led to a dramatic rise in the number of ablation procedures worldwide for treatment of symptomatic or drug-refractory patients with AF, becomin
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