A Case Report of Atrio-Esophageal Fistula Caused by Percutaneous Transcatheter Ablation of Atrial Fibrillation / 日本心臓血管外科学会雑誌

ABSTRACT

A 66-year-old man underwent percutaneous transcatheter ablation of the myocardium to treat chronic atrial fibrillation. Fifteen days after the procedure, he visited our hospital with a chief complaint of hematemesis. At that time, upper gastrointestinal endoscopy led to a diagnosis of esophageal ulcer. Oral food intake was suspended for approximately 1 month. Subsequently, 4 days after resumption of oral intake, he developed multiple cerebral infarcts. Moreover, massive hematemesis occurred, with resultant shock and cardiopulmonary arrest. At this point, a definitive diagnosis of left atrio-esophageal fistula resulting from the injury relating to the transcatheter ablation was made. Cardiopulmonary resuscitation was carried out, followed by emergency surgery. The operation was performed via median sternotomy and was done under cardiac arrest using complete extracorporeal bypass, and the fistula in the posterior left atrial wall and the middle esophagus were directly sutured for closure. Unfortunately, 3 days after this open heart surgery, the patient died from low cardiac output syndrome and multiple organ failure. Although rare, this complication may be fatal when it develops then its prevention is important. Once atrio-esophageal fistula develops after percutaneous transcatheter ablation, immediate surgical intervention seems essential.