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Temporary esophageal stenting allows healing of esophageal perforations following atrial fibrillation ablation procedures.
- Source :
-
Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2006 Apr; Vol. 17 (4), pp. 435-9. - Publication Year :
- 2006
-
Abstract
- Background: Left atrial catheter ablation (LACA) has emerged as a successful method to eliminate atrial fibrillation (AF). Recent reports have described atrio-esophageal fistulas, often resulting in death, from this procedure. Temporary esophageal stenting is an established therapy for malignant esophageal disease. We describe the first case of successful temporary esophageal stenting for an esophageal perforation following LACA.<br />Case: A 48-year-old man with symptomatic drug refractory lone AF underwent an uneventful LACA. Fifty-nine ablations with an 8-mm tip ablation catheter (30 seconds, 70 Watts, 55 degrees C), as guided by 3-D NavX mapping, were performed in the left atrium to isolate the pulmonary veins as well as a left atrial flutter and roof ablation line. In addition, complex atrial electrograms in AF and sites of vagal innervation were ablated. Two weeks later, he presented with sub-sternal chest pain, fever, and dysphagia. A chest CT showed a 3-mm esophageal perforation at the level of the left atrium with mediastinal soiling and no pericardial effusion. An urgent upper endoscopy with placement of a PolyFlex removable esophageal stent to seal off the esophago-mediastinal fistula was performed. After 3 weeks of i.v. antibiotics, naso-jejunal tube feedings, and esophageal stenting, the perforation resolved and the stent was removed. Over 18 months of follow-up, there have been no other complications, and he has returned to a physically active life and remains free from AF on previously ineffective anti-arrhythmic drugs.<br />Conclusion: Early diagnosis of esophageal perforations following LACA may allow temporary esophageal stenting with successful esophageal healing. Prompt chest CT scans with oral and i.v. contrast should be considered in any patient with sub-sternal chest pain or dysphagia following LACA.
- Subjects :
- Endoscopy, Gastrointestinal
Follow-Up Studies
Humans
Intraoperative Complications diagnosis
Intraoperative Complications etiology
Male
Middle Aged
Rupture
Stents
Tomography, X-Ray Computed
Atrial Fibrillation surgery
Catheter Ablation adverse effects
Esophagus injuries
Esophagus surgery
Intraoperative Complications surgery
Prosthesis Implantation methods
Subjects
Details
- Language :
- English
- ISSN :
- 1045-3873
- Volume :
- 17
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 16643370
- Full Text :
- https://doi.org/10.1111/j.1540-8167.2006.00464.x