Radiofrequency Catheter Ablation Essay
The Way to A Man’s Heart Shouldn’t Be Through His Esophagus
Elise Landa MD, Amin Pasha MD, Robby Singh MD, Christian Machado MD
Providence-Providence Park Hospital/Michigan State University College of Human Medicine, Southfield, Michigan
Introduction:
Radiofrequency catheter ablation is a very commonly performed procedure, for curative treatment of atrial fibrillation (AF). Although it is an effective and safe procedure, it is not without risk. The development of an Atrioesophageal fistula (AEF) is a rare but potentially fatal complication. As per previously described cases, surgery is the definite therapy for an AEF. However, establishing the diagnosis is remains extremely challenging. We describe one such case of AEF after radiofrequency ablation.
Case:
A …show more content…
AEF symptoms are not specific which can lead to a delay in diagnosis. Patients often present with hemoptysis and sepsis. The median time for presentation is between day 6 and 59 post-ablation. The reported fatality rate is between 67-100%. As per the literature, there are three strategies that have been attempted in treating AEF - conservative management, esophageal stenting and surgical repair of the fistula. Conservative management results a fatality rate approaching 100%. Esophageal stenting is potentially of benefit in patients in whom esophageal perforation is present without fistula formation to the left atrium. The most successful treatment for proven or suspected AEF is surgery with repair of all damaged tissue. It is recommended that a multidisciplinary approach to care be used with coordination between the surgery, infectious disease, neurology and critical care personnel. Improving the awareness of this complication among primary care physicians and emergency medical professionals is required to decrease morbidity and mortality. Early diagnosis and surgery remains the mainstay in
Elise Landa MD, Amin Pasha MD, Robby Singh MD, Christian Machado MD
Providence-Providence Park Hospital/Michigan State University College of Human Medicine, Southfield, Michigan
Introduction:
Radiofrequency catheter ablation is a very commonly performed procedure, for curative treatment of atrial fibrillation (AF). Although it is an effective and safe procedure, it is not without risk. The development of an Atrioesophageal fistula (AEF) is a rare but potentially fatal complication. As per previously described cases, surgery is the definite therapy for an AEF. However, establishing the diagnosis is remains extremely challenging. We describe one such case of AEF after radiofrequency ablation.
Case:
A …show more content…
AEF symptoms are not specific which can lead to a delay in diagnosis. Patients often present with hemoptysis and sepsis. The median time for presentation is between day 6 and 59 post-ablation. The reported fatality rate is between 67-100%. As per the literature, there are three strategies that have been attempted in treating AEF - conservative management, esophageal stenting and surgical repair of the fistula. Conservative management results a fatality rate approaching 100%. Esophageal stenting is potentially of benefit in patients in whom esophageal perforation is present without fistula formation to the left atrium. The most successful treatment for proven or suspected AEF is surgery with repair of all damaged tissue. It is recommended that a multidisciplinary approach to care be used with coordination between the surgery, infectious disease, neurology and critical care personnel. Improving the awareness of this complication among primary care physicians and emergency medical professionals is required to decrease morbidity and mortality. Early diagnosis and surgery remains the mainstay in