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Clinical presentation, diagnosis, and treatment of atrioesophageal fistula resulting from atrial fibrillation ablation
Author(s) -
Della Rocca Domenico G.,
Magnocavallo Michele,
Natale Veronica N.,
Gianni Carola,
Mohanty Sanghamitra,
Trivedi Chintan,
Lavalle Carlo,
Forleo Giovanni B.,
Tarantino Nicola,
Romero Jorge,
Zhang Xiadong,
Bassiouny Mohamed,
AlAhmad Amin,
Burkhardt David J.,
Gallinghouse Joseph G.,
Sanchez Javier E.,
Horton Rodney P.,
Di Biase Luigi,
Natale Andrea
Publication year - 2021
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/jce.15168
Subject(s) - medicine , interquartile range , atrial fibrillation , magnetic resonance imaging , ablation , radiology , catheter ablation , fistula , surgery
Background Atrioesophageal fistula (AEF) is a worrisome complication of atrial fibrillation (AF) ablation. Its clinical manifestations and time course are unpredictable and may contribute to diagnostic and treatment delays. We conducted a systematic review of all available cases of AEF, aiming at characterizing clinical presentation, time course, diagnostic pitfalls, and outcomes. Methods The digital search retrieved 150 studies containing 257 cases, 238 (92.6%) of which with a confirmed diagnosis of AEF and 19 (7.4%) of pericardioesophageal fistula. Results The median time from ablation to symptom onset was 21 days (interquartile range [IQR]: 11–28). Neurological abnormalities were documented in 75% of patients. Compared to patients seen by a specialist, those evaluated at a walk‐in clinic or community hospital had a significantly greater delay between symptom onset and hospital admission (median: 2.5 day [IQR: 1–8] vs. 1 day [IQR: 1–5); p = .03). Overall, 198 patients underwent a chest scan (computed tomography [CT]: 192 patients and magnetic resonance imaging [MRI]: 6 patients), 48 (24.2%; 46 CT and 2 MRI) of whom had normal/unremarkable findings. Time from hospital admission to diagnostic confirmation was significantly longer in patients with a first normal/unremarkable chest scan ( p < .001). Overall mortality rate was 59.3% and 26.0% survivors had residual neurological deficits at the time of discharge. Conclusions Since healthcare professionals of any specialty might be involved in treating AEF patients, awareness of the clinical manifestations, diagnostic pitfalls, and time course, as well as an early contact with the treating electrophysiologist for a coordinated interdisciplinary medical effort, are pivotal to prevent diagnostic delays and reduce mortality.