Citation, DOI, disclosures and article data
Citation:
Kelsch R, Weerakkody Y, Abu-Shaban K, et al. Atrio-esophageal fistula. Reference article, Radiopaedia.org (Accessed on 25 Feb 2025) https://doi.org/10.53347/rID-41801
Atrio-esophageal fistulas are rare pathological connections between the left atrium and the esophagus.
The presentation is non-specific. Patients may complain of fever, malaise, and/or dysphagia, or present with neurological symptoms 3.
The chief cause of atrial-esophageal fistulas is iatrogenic in the setting of cardiac ablation procedures (e.g. PVI ablation), although, theoretically, many mediastinal pathology or procedure could potentially cause a fistula.
Complications
CT
CT is the modality of choice and may reveal communication between the left atrium and the esophagus which can be evidenced by IV contrast present in the esophagus.
Other possible features include:
Treatment and prognosis
The treatment is surgical, including resection and repair of the necrotic heart tissue and esophageal resection of the fistulous area. Esophageal stenting can be used as a temporizing measure. The mortality rate is high at ~60% (range 40-80%).
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