The atrioesophageal fistula (AEF) is a rare complication of the atrial fibrillation (AF) ablation procedure. This complication is mostly fatal, with a mortality rate exceeding 80% (1), while its incidence does not exceed 0.3% (1). It is the second cause of death after tamponade following this procedure (2). The AEF results from the proximity between the esophagus and left atrium (3), as well as fromthermal esophageal mucosal lesions (4). We have here reported the case of a 65-year-old man who developed neurologic and septic symptoms 31 days after a second AF ablation. Upon admission, a cerebral scanner revealed a small ischemic lesion in the right temporal lobe. Initially hospitalized in a stroke unit, the patient was then transferred to an ICU because of his rapid neurologic deterioration. Upon the intubation maneuver, massive hemorrhaging from an upper digestive site occurred, with patient reanimation required. Confronted with an unknown diagnosis, a gastric endoscopy was performed, revealing two sluices on the anterior esophagus surface, opposite the left atrium. Thoracic CT scan corroborated the AEF diagnosis with an air bubble observed in the mediastinum, between esophagus and left atrium. Nevertheless, the patient died owing to massive cerebral air embolism.
What is already known about the topic?
- The atrio-esophageal fistula (AEF) is a rare complication of the atrial fibrillation (AF) ablation procedure. This complication is mostly fatal, with a mortality rate exceeding 80% (1-6), while its incidence does not exceed 0.3% (1).
- The onset of mild symptoms is usually delayed from 2 to 42 days post-ablation (7), rendering the diagnosis difficult.
What does this article bring up for us?
- This article is a reminder of the pathophysiology and prevention of AEF, while providing advices on the management of this rare pathology.
- It is also meant to be a warning on certain management errors.
Key words
Atrioesophageal fistula, radiofrequency catheter ablation, atrial fibrillation