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Rapid Detection and Successful Treatment of Esophageal Perforation After Radiofrequency Ablation of Atrial Fibrillation: Lessons from Five Cases
Author(s) -
DAGRES NIKOLAOS,
KOTTKAMP HANS,
PIORKOWSKI CHRISTOPHER,
DOLL NICOLAS,
MOHR FRIEDRICH,
HORLITZ MARC,
KREMASTINOS DIMITRIOS TH.,
HINDRICKS GERHARD
Publication year - 2006
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2006.00611.x
Subject(s) - medicine , leukocytosis , perforation , surgery , atrial fibrillation , epigastric pain , radiofrequency ablation , chest pain , ablation , percutaneous , vomiting , materials science , punching , metallurgy
The aim of the study was to identify criteria for rapid recognition and successful treatment of esophageal perforation after radiofrequency ablation for atrial fibrillation (AF). Methods and Results: Esophageal perforation occurred in five patients after intraoperative (n = 4) or percutaneous (n = 1) AF ablation. Patients presented with high fever (n = 3) or severe chest/epigastric pain (n = 2) 8–28 days after ablation. WBC count was elevated at presentation in all patients (15,460 ± 2,910/μL), CRP showed a delayed rise. Thoracic CT detected free air in all. Neurologic complications occurred in three cases (60%) with a delay of 5–40 hours after first symptoms. Only one (20%) developed neurologic complications within the first 24 hours. Two patients (40%) died before surgery could be performed. In both, time from symptom onset to diagnosis was significant (24 and 36 hours). Three patients (60%) underwent esophageal resection and survived. In two of them, treatment was rapid with time from symptoms to surgery of 24 hours; they had favorable outcome. In the third surviving patient, surgery was late (5 days after first symptoms); permanent neurologic residues remained. Conclusion: The leading symptom of esophageal perforation is high fever or severe chest/epigastric pain. Fever is not necessarily present. Leukocytosis is the earliest and most sensitive laboratory marker, thoracic CT the most valuable diagnostic examination. The dramatic neurologic complications occur with a delay of at least a few hours after first symptoms. Immediate surgery may prevent neurologic complications and could possibly result in a high survival rate without residues. Delay of treatment seems to have devastating results.