Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting

J Cardiovasc Electrophysiol. 2014 Jun;25(6):579-84. doi: 10.1111/jce.12386.


Introduction: Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies.

Methods: Nine patients with AEF post-RFCA for AF were included in this study. AEF was diagnosed based on symptoms and chest CT imaging. Of the 9 patients, 5 received stents and 4 underwent surgical repair of fistula.

Results: AF ablation was performed under general anesthesia (n = 4) or conscious sedation (n = 5). During ablation, RF power was maintained between 25 and 35 Watts in areas close to the esophagus and energy delivery discontinued when esophageal temperature reached 38 °C. Seven patients underwent ablation with 3.5-mm open-irrigated catheter, 1 with 8-mm nonirrigated catheter, and 1 had surgical epicardial ablation. Seven patients received proton pump inhibitor and sucralfate before and after procedure. AEF symptoms developed within 2–6 weeks from ablation. Esophageal stenting was performed in 5 patients (median age 58 years, median time from RFCA 4 weeks) and 4 underwent surgical repair (median age 54 years, median time from RFCA 4 weeks) within 2–4 hours from diagnosis. All 5 patients receiving stents died within 1 week of the procedure due to cerebral embolism, septic shock, or respiratory failure. On the other hand, the 4 patients that received surgical repair were alive at median follow-up of 2.1 years (P = 0.005).

Conclusions: Esophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / adverse effects*
  • Cohort Studies
  • Esophageal Fistula / diagnosis
  • Esophageal Fistula / etiology*
  • Female
  • Heart Atria / injuries*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology*
  • Stents*
  • Treatment Outcome