Atrio-esophageal fistula: Difference between revisions
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==Background== | ==Background== <!--T:1--> | ||
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[[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | [[File:Gray1032.png|thumb|Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.]] | ||
[[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | [[File:Layers of the GI Tract english.svg|thumb|Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.]] | ||
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==Clinical Features== | ==Clinical Features== <!--T:3--> | ||
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*Most common presenting symptoms: | *Most common presenting symptoms: | ||
**[[Special:MyLanguage/Fever|Fever]] | **[[Special:MyLanguage/Fever|Fever]] | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:5--> | ||
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*[[Special:MyLanguage/Sepsis|Sepsis]] | *[[Special:MyLanguage/Sepsis|Sepsis]] | ||
*[[Special:MyLanguage/Stroke|Stroke]]/[[Special:MyLanguage/TIA|TIA]] | *[[Special:MyLanguage/Stroke|Stroke]]/[[Special:MyLanguage/TIA|TIA]] | ||
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==Evaluation== | ==Evaluation== <!--T:7--> | ||
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[[File:PMC3631790 kjtcs-46-142-g003.png|thumb|Chest CT demonstrating pneumomediastinum after cardiac radiofrequency catheter ablation for refractory atrial fibrillation.]] | [[File:PMC3631790 kjtcs-46-142-g003.png|thumb|Chest CT demonstrating pneumomediastinum after cardiac radiofrequency catheter ablation for refractory atrial fibrillation.]] | ||
*CT chest with contrast is the recommended modality, but repeat testing may be needed for eventual diagnosis <ref> Han H-C, Hui-Chen Han From the Austin Health, Ha FJ, et al. Atrioesophageal Fistula. Circulation: Arrhythmia and Electrophysiology. https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.005579. Published November 6, 2017. Accessed December 14, 2020. </ref> | *CT chest with contrast is the recommended modality, but repeat testing may be needed for eventual diagnosis <ref> Han H-C, Hui-Chen Han From the Austin Health, Ha FJ, et al. Atrioesophageal Fistula. Circulation: Arrhythmia and Electrophysiology. https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.005579. Published November 6, 2017. Accessed December 14, 2020. </ref> | ||
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==Management== | ==Management== <!--T:9--> | ||
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*Mortality is high in all patients | *Mortality is high in all patients | ||
*Surgery has the best mortality benefit, followed by endoscopic intervention | *Surgery has the best mortality benefit, followed by endoscopic intervention | ||
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==Disposition== | ==Disposition== <!--T:11--> | ||
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*Admission | *Admission | ||
*Surgery consultation | *Surgery consultation | ||
==See Also== | ==See Also== <!--T:13--> | ||
==External Links== | ==External Links== <!--T:14--> | ||
==References== | ==References== <!--T:15--> | ||
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<references/> | <references/> | ||
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[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:GI]] | [[Category:GI]] | ||
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Latest revision as of 20:35, 6 January 2026
Background
- Rare but deadly complication of atrial ablation
- There have been reported cases with various ablation modalities (including radiofrequency ablation, cryoablation, high intensity focused ultrasound, and surgical ablation)
- Incidence is low (<0.1%) [1]
- Usually formed between esophagus and left atrium
- Thought to be related to adverse healing secondary to esophageal injury during the ablation procedure
Clinical Features
- Most common presenting symptoms:
- Fever
- Neurological symptoms (including focal neurological symptoms, seizure, AMS)
- Gastrointestinal symptoms (including hematemesis, melena, dysphagia, nausea/vomiting)
- Chest pain
- Most common time frame to presentation is 2-4 weeks post procedure but can occur up to 2 months post procedure
Differential Diagnosis
Chest pain
Critical
- Acute coronary syndromes (ACS)
- Aortic dissection
- Cardiac tamponade
- Coronary artery dissection
- Esophageal perforation (Boerhhaave's syndrome)
- Pulmonary embolism
- Tension pneumothorax
Emergent
- Cholecystitis
- Cocaine-associated chest pain
- Mediastinitis
- Myocardial rupture
- Myocarditis
- Pancreatitis
- Pericarditis
- Pneumothorax
Nonemergent
- Aortic stenosis
- Arthritis
- Asthma exacerbation
- Biliary colic
- Costochondritis
- Esophageal spasm
- Gastroesophageal reflux disease
- Herpes zoster / Postherpetic Neuralgia
- Hypertrophic cardiomyopathy
- Hyperventilation
- Mitral valve prolapse
- Panic attack
- Peptic ulcer disease
- Pleuritis
- Pneumomediastinum
- Pneumonia
- Rib fracture
- Stable angina
- Thoracic outlet syndrome
- Valvular heart disease
- Muscle sprain
- Psychologic / Somatic Chest Pain
- Spinal Root Compression
- Tumor
Evaluation
- CT chest with contrast is the recommended modality, but repeat testing may be needed for eventual diagnosis [2]
- Endoscopy may be considered, but may be associated an increased risk of clinical deterioration
- Transthoracic and transesophageal echocardiography have not been found to be highly sensitive
Management
- Mortality is high in all patients
- Surgery has the best mortality benefit, followed by endoscopic intervention
- Nonintervention has the worst outcome
Disposition
- Admission
- Surgery consultation
See Also
External Links
References
- ↑ Nair KK, Danon A, Valaparambil A, Koruth JS, Singh SM. Atrioesophageal Fistula: A Review. J Atr Fibrillation. 2015;8(3):1331. Published 2015 Oct 31. doi:10.4022/jafib.1331
- ↑ Han H-C, Hui-Chen Han From the Austin Health, Ha FJ, et al. Atrioesophageal Fistula. Circulation: Arrhythmia and Electrophysiology. https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.005579. Published November 6, 2017. Accessed December 14, 2020.