Characteristics of atrial fibrillation patients suffering atrioesophageal fistula after radiofrequency catheter ablation

Yun Gi Kim, Jaemin Shim, Dong Hyeok Kim, Jongil Choi, Sang Weon Park, Hui Nam Pak, Young Hoon Kim

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: Radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients can cause various complications and atrioesophageal (AE) fistula is one of the most catastrophic complications of RFCA. Methods and results: RFCA registries from 3 cardiovascular centers in the Republic of Korea consisted of 5721 patients undergoing 6724 procedures. Before undergoing RFCA, patients underwent either computed tomography or magnetic resonance imaging. We evaluated clinical, anatomical, and procedural characteristics of patients who developed AE fistula after RFCA. A total of 10 patients developed AE fistula after RFCA (0.15% per procedure). All AE fistulas occurred during first-time RFCA. Eight patients died and mortality rate was 80.0%. No patients had any gastrointestinal symptom at the time of discharge and mean duration time from RFCA to symptom onset was 23.4 days. Six patients (60.0%) had paroxysmal AF. Substrate modification in addition to pulmonary vein isolation was performed in 4 patients (40.0%). Patients with old age, low body weight, and high CHA2DS2-VASc score were at increased risk of AE fistula. Baseline imaging evaluation revealed that esophagus had closest contact with LA posterior wall near left inferior pulmonary vein rather than left superior pulmonary vein and all documented AE fistulas were located near left inferior pulmonary vein. Conclusion: Posterior wall of LA near left inferior pulmonary vein was the most vulnerable location for AE fistula. Pulmonary vein isolation was the main lesion set associated with AE fistula and old age, low body weight, and high CHA2DS2-VASc score were significant risk factors for AE fistula. Journal compilation

Original languageEnglish
JournalJournal of Cardiovascular Electrophysiology
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Catheter Ablation
Atrial Fibrillation
Fistula
Pulmonary Veins
Body Weight
Republic of Korea
Esophagus
Registries
Tomography
Magnetic Resonance Imaging

Keywords

  • Atrial fibrillation
  • Atrioesophageal fistula
  • Complication
  • Radiofrequency catheter ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{25832db765864ba89b450ea40d24548a,
title = "Characteristics of atrial fibrillation patients suffering atrioesophageal fistula after radiofrequency catheter ablation",
abstract = "Introduction: Radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients can cause various complications and atrioesophageal (AE) fistula is one of the most catastrophic complications of RFCA. Methods and results: RFCA registries from 3 cardiovascular centers in the Republic of Korea consisted of 5721 patients undergoing 6724 procedures. Before undergoing RFCA, patients underwent either computed tomography or magnetic resonance imaging. We evaluated clinical, anatomical, and procedural characteristics of patients who developed AE fistula after RFCA. A total of 10 patients developed AE fistula after RFCA (0.15{\%} per procedure). All AE fistulas occurred during first-time RFCA. Eight patients died and mortality rate was 80.0{\%}. No patients had any gastrointestinal symptom at the time of discharge and mean duration time from RFCA to symptom onset was 23.4 days. Six patients (60.0{\%}) had paroxysmal AF. Substrate modification in addition to pulmonary vein isolation was performed in 4 patients (40.0{\%}). Patients with old age, low body weight, and high CHA2DS2-VASc score were at increased risk of AE fistula. Baseline imaging evaluation revealed that esophagus had closest contact with LA posterior wall near left inferior pulmonary vein rather than left superior pulmonary vein and all documented AE fistulas were located near left inferior pulmonary vein. Conclusion: Posterior wall of LA near left inferior pulmonary vein was the most vulnerable location for AE fistula. Pulmonary vein isolation was the main lesion set associated with AE fistula and old age, low body weight, and high CHA2DS2-VASc score were significant risk factors for AE fistula. Journal compilation",
keywords = "Atrial fibrillation, Atrioesophageal fistula, Complication, Radiofrequency catheter ablation",
author = "Kim, {Yun Gi} and Jaemin Shim and Kim, {Dong Hyeok} and Jongil Choi and Park, {Sang Weon} and Pak, {Hui Nam} and Kim, {Young Hoon}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/jce.13671",
language = "English",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Characteristics of atrial fibrillation patients suffering atrioesophageal fistula after radiofrequency catheter ablation

AU - Kim, Yun Gi

AU - Shim, Jaemin

AU - Kim, Dong Hyeok

AU - Choi, Jongil

AU - Park, Sang Weon

AU - Pak, Hui Nam

AU - Kim, Young Hoon

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: Radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients can cause various complications and atrioesophageal (AE) fistula is one of the most catastrophic complications of RFCA. Methods and results: RFCA registries from 3 cardiovascular centers in the Republic of Korea consisted of 5721 patients undergoing 6724 procedures. Before undergoing RFCA, patients underwent either computed tomography or magnetic resonance imaging. We evaluated clinical, anatomical, and procedural characteristics of patients who developed AE fistula after RFCA. A total of 10 patients developed AE fistula after RFCA (0.15% per procedure). All AE fistulas occurred during first-time RFCA. Eight patients died and mortality rate was 80.0%. No patients had any gastrointestinal symptom at the time of discharge and mean duration time from RFCA to symptom onset was 23.4 days. Six patients (60.0%) had paroxysmal AF. Substrate modification in addition to pulmonary vein isolation was performed in 4 patients (40.0%). Patients with old age, low body weight, and high CHA2DS2-VASc score were at increased risk of AE fistula. Baseline imaging evaluation revealed that esophagus had closest contact with LA posterior wall near left inferior pulmonary vein rather than left superior pulmonary vein and all documented AE fistulas were located near left inferior pulmonary vein. Conclusion: Posterior wall of LA near left inferior pulmonary vein was the most vulnerable location for AE fistula. Pulmonary vein isolation was the main lesion set associated with AE fistula and old age, low body weight, and high CHA2DS2-VASc score were significant risk factors for AE fistula. Journal compilation

AB - Introduction: Radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients can cause various complications and atrioesophageal (AE) fistula is one of the most catastrophic complications of RFCA. Methods and results: RFCA registries from 3 cardiovascular centers in the Republic of Korea consisted of 5721 patients undergoing 6724 procedures. Before undergoing RFCA, patients underwent either computed tomography or magnetic resonance imaging. We evaluated clinical, anatomical, and procedural characteristics of patients who developed AE fistula after RFCA. A total of 10 patients developed AE fistula after RFCA (0.15% per procedure). All AE fistulas occurred during first-time RFCA. Eight patients died and mortality rate was 80.0%. No patients had any gastrointestinal symptom at the time of discharge and mean duration time from RFCA to symptom onset was 23.4 days. Six patients (60.0%) had paroxysmal AF. Substrate modification in addition to pulmonary vein isolation was performed in 4 patients (40.0%). Patients with old age, low body weight, and high CHA2DS2-VASc score were at increased risk of AE fistula. Baseline imaging evaluation revealed that esophagus had closest contact with LA posterior wall near left inferior pulmonary vein rather than left superior pulmonary vein and all documented AE fistulas were located near left inferior pulmonary vein. Conclusion: Posterior wall of LA near left inferior pulmonary vein was the most vulnerable location for AE fistula. Pulmonary vein isolation was the main lesion set associated with AE fistula and old age, low body weight, and high CHA2DS2-VASc score were significant risk factors for AE fistula. Journal compilation

KW - Atrial fibrillation

KW - Atrioesophageal fistula

KW - Complication

KW - Radiofrequency catheter ablation

UR - http://www.scopus.com/inward/record.url?scp=85050945606&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050945606&partnerID=8YFLogxK

U2 - 10.1111/jce.13671

DO - 10.1111/jce.13671

M3 - Article

C2 - 29927012

AN - SCOPUS:85050945606

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

ER -