Circulation. 2004;109:2724-2726
Published online before print May 24, 2004, doi: 10.1161/01.CIR.0000131866.44650.46
Published online before print May 24, 2004, doi: 10.1161/01.CIR.0000131866.44650.46
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(Circulation. 2004;109:2724-2726.)
© 2004 American Heart Association, Inc.
Brief Rapid Communications |
Atrio-Esophageal Fistula as a Complication of Percutaneous Transcatheter Ablation of Atrial Fibrillation
From the San Raffaele University Hospital, Milan, Italy (C.P., V.S., H.O., G.V., C.C.L., F.M., L.T., S.B., O.A.); Queen’s Medical Center, Honolulu, Hawaii (R.H., W.L., K.H., N.S.); and Division of Cardiology, Department of Medicine, University of Michigan Health System, Ann Arbor (H.O., B.H., F.M.).
Correspondence to Carlo Pappone, MD, Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. E-mail carlo.pappone{at}hsr.it
Received March 19, 2004; revision received April 20, 2004; accepted April 27, 2004.
Background— Radiofrequency ablation for atrial fibrillation is becoming widely practiced.
Methods and Results— Two patients undergoing circumferential pulmonary vein ablation for atrial fibrillation in different centers developed symptoms compatible with endocarditis 3 to 5 days after the procedure. Their clinical condition deteriorated rapidly, and both suffered multiple gaseous and/or septic embolic events causing cerebral and myocardial damage. One patient survived after emergency cardiac and esophageal surgery; the other died of extensive systemic embolization. An atrio-esophageal fistula was identified in both patients.
Conclusions— Atrio-esophageal fistulas can occur after catheter ablation in the posterior wall of the left atrium. This diagnosis should be excluded in any patient with symptoms or signs of endocarditis after left atrial ablation, and expeditious cardiac surgery is critical if the diagnosis is confirmed. Lower power and temperature settings for applications of radiofrequency energy along the posterior left atrial wall may prevent further cases of fistula formation.
Key Words: arrhythmia • ablation • surgery • fistula
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T. J. Bunch, S. Mahapatra, G. K. Bruce, S. B. Johnson, D. V. Miller, B. D. Horne, X.-L. Wang, H.-C. Lee, N. M. Caplice, and D. L. Packer Impact of Transforming Growth Factor-{beta}1 on Atrioventricular Node Conduction Modification by Injected Autologous Fibroblasts in the Canine Heart Circulation, May 30, 2006; 113(21): 2485 - 2494. [Abstract] [Full Text] [PDF]
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H. Oral, A. Chugh, E. Good, S. Sankaran, S. S. Reich, P. Igic, D. Elmouchi, D. Tschopp, T. Crawford, S. Dey, et al. A Tailored Approach to Catheter Ablation of Paroxysmal Atrial Fibrillation Circulation, April 18, 2006; 113(15): 1824 - 1831. [Abstract] [Full Text] [PDF]
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C. Pappone, G. Vicedomini, F. Manguso, F. Gugliotta, P. Mazzone, S. Gulletta, N. Sora, S. Sala, A. Marzi, G. Augello, et al. Robotic Magnetic Navigation for Atrial Fibrillation Ablation J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1390 - 1400. [Abstract] [Full Text] [PDF]
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P. Schley, H. Gulker, and M. Horlitz Atrio-oesophageal fistula following circumferential pulmonary vein ablation: verification of diagnosis with multislice computed tomography. Europace, March 1, 2006; 8(3): 189 - 190. [Full Text] [PDF]
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A. Chugh, R. Latchamsetty, H. Oral, D. Elmouchi, D. Tschopp, S. Reich, P. Igic, T. Lemerand, E. Good, F. Bogun, et al. Characteristics of Cavotricuspid Isthmus-Dependent Atrial Flutter After Left Atrial Ablation of Atrial Fibrillation Circulation, February 7, 2006; 113(5): 609 - 615. [Abstract] [Full Text] [PDF]
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P. Kotini, S. Mohler, K. A. Ellenbogen, and M. A. Wood Detection of microbubble formation during radiofrequency ablation using phonocardiography. Europace, January 1, 2006; 8(5): 333 - 335. [Abstract] [Full Text] [PDF]
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M. Hocini, P. Jais, P. Sanders, Y. Takahashi, M. Rotter, T. Rostock, L.-F. Hsu, F. Sacher, S. Reuter, J. Clementy, et al. Techniques, Evaluation, and Consequences of Linear Block at the Left Atrial Roof in Paroxysmal Atrial Fibrillation: A Prospective Randomized Study Circulation, December 13, 2005; 112(24): 3688 - 3696. [Abstract] [Full Text] [PDF]
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E. Good, H. Oral, K. Lemola, J. Han, K. Tamirisa, P. Igic, D. Elmouchi, D. Tschopp, S. Reich, A. Chugh, et al. Movement of the Esophagus During Left Atrial Catheter Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2107 - 2110. [Abstract] [Full Text] [PDF]
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H. Aupperle, N. Doll, T. Walther, P. Kornherr, C. Ullmann, H.-A. Schoon, and F. W. Mohr Ablation of atrial fibrillation and esophageal injury: Effects of energy source and ablation technique J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1549 - 1554. [Abstract] [Full Text] [PDF]
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V. Essebag, F. Baldessin, M. R. Reynolds, S. McClennen, J. Shah, K. F. Kwaku, P. Zimetbaum, and M. E. Josephson Non-inducibility post-pulmonary vein isolation achieving exit block predicts freedom from atrial fibrillation Eur. Heart J., December 1, 2005; 26(23): 2550 - 2555. [Abstract] [Full Text] [PDF]
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F R Quinn and A C Rankin Atrial fibrillation ablation in the real world Heart, December 1, 2005; 91(12): 1507 - 1508. [Abstract] [Full Text] [PDF]
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A. V. Sarabanda, T. J. Bunch, S. B. Johnson, S. Mahapatra, M. A. Milton, L. R. Leite, G. K. Bruce, and D. L. Packer Efficacy and Safety of Circumferential Pulmonary Vein Isolation Using a Novel Cryothermal Balloon Ablation System J. Am. Coll. Cardiol., November 15, 2005; 46(10): 1902 - 1912. [Abstract] [Full Text] [PDF]
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F. Ouyang, S. Ernst, J. Chun, D. Bansch, Y. Li, A. Schaumann, H. Mavrakis, X. Liu, F. T. Deger, B. Schmidt, et al. Electrophysiological Findings During Ablation of Persistent Atrial Fibrillation With Electroanatomic Mapping and Double Lasso Catheter Technique Circulation, November 15, 2005; 112(20): 3038 - 3048. [Abstract] [Full Text] [PDF]
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H.-M. Tsao, M.-H. Wu, S. Higa, K.-T. Lee, C.-T. Tai, N.-W. Hsu, C.-Y. Chang, and S.-A. Chen Anatomic Relationship of the Esophagus and Left Atrium: Implication for Catheter Ablation of Atrial Fibrillation Chest, October 1, 2005; 128(4): 2581 - 2587. [Abstract] [Full Text] [PDF]
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K. Lemola, H. Oral, A. Chugh, B. Hall, P. Cheung, J. Han, K. Tamirisa, E. Good, F. Bogun, F. Pelosi Jr, et al. Pulmonary Vein Isolation as an End Point for Left Atrial Circumferential Ablation of Atrial Fibrillation J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1060 - 1066. [Abstract] [Full Text] [PDF]
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D. Sanchez-Quintana, J. A. Cabrera, V. Climent, J. Farre, M. C. de Mendonca, and S. Y. Ho Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation Circulation, September 6, 2005; 112(10): 1400 - 1405. [Abstract] [Full Text] [PDF]
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R. K. Wolf, E. W. Schneeberger, R. Osterday, D. Miller, W. Merrill, J. B. Flege Jr, and A. M. Gillinov Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 797 - 802. [Abstract] [Full Text] [PDF]
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T. Deneke, K. Khargi, K.-M. Muller, B. Lemke, A. Mugge, A. Laczkovics, A. E. Becker, and P. H. Grewe Histopathology of intraoperatively induced linear radiofrequency ablation lesions in patients with chronic atrial fibrillation Eur. Heart J., September 1, 2005; 26(17): 1797 - 1803. [Abstract] [Full Text] [PDF]
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A. Verma, A. Natale, B. J. Padanilam, E. N. Prystowsky, A. Verma, A. Natale, B. J. Padanilam, and E. N. Prystowsky Why Atrial Fibrillation Ablation Should Be Considered First-Line Therapy for Some Patients Circulation, August 23, 2005; 112(8): 1214 - 1222. [Full Text] [PDF]
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B. J. Padanilam and E. N. Prystowsky Should Ablation Be First-Line Therapy and for Whom: The Antagonist Position Circulation, August 23, 2005; 112(8): 1223 - 1231. [Full Text] [PDF]
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G. K. Bruce, T. J. Bunch, M. A. Milton, A. Sarabanda, S. B. Johnson, and D. L. Packer Discrepancies Between Catheter Tip and Tissue Temperature in Cooled-Tip Ablation: Relevance to Guiding Left Atrial Ablation Circulation, August 16, 2005; 112(7): 954 - 960. [Abstract] [Full Text] [PDF]
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J. E. Cummings, R. A. Schweikert, W. I. Saliba, J. D. Burkhardt, J. Brachmann, J. Gunther, V. Schibgilla, A. Verma, M. Dery, J. L. Drago, et al. Assessment of Temperature, Proximity, and Course of the Esophagus During Radiofrequency Ablation Within the Left Atrium Circulation, July 26, 2005; 112(4): 459 - 464. [Abstract] [Full Text] [PDF]
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D. Shah, J.-M. Dumonceau, H. Burri, H. Sunthorn, A. Schroft, P. Gentil-Baron, Y. Yokoyama, and A. Takahashi Acute Pyloric Spasm and Gastric Hypomotility: An Extracardiac Adverse Effect of Percutaneous Radiofrequency Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., July 19, 2005; 46(2): 327 - 330. [Abstract] [Full Text] [PDF]
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A. Chugh, H. Oral, E. Good, J. Han, K. Tamirisa, K. Lemola, D. Elmouchi, D. Tschopp, S. Reich, P. Igic, et al. Catheter Ablation of Atypical Atrial Flutter and Atrial Tachycardia Within the Coronary Sinus After Left Atrial Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., July 5, 2005; 46(1): 83 - 91. [Abstract] [Full Text] [PDF]
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