Citation, DOI, disclosures and article data
Citation:
Kelsch R, Weerakkody Y, Abu-Shaban K, et al. Atrio-oesophageal fistula. Reference article, Radiopaedia.org (Accessed on 24 Apr 2024) https://doi.org/10.53347/rID-41801
Atrio-oesophageal fistulas are rare pathological connections between the left atrium and the oesophagus.
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-oesophageal 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 oesophagus which can be evidenced by IV contrast present in the oesophagus.
Other possible features include:
Treatment and prognosis
The treatment is surgical, including resection and repair of the necrotic heart tissue and oesophageal resection of the fistulous area. Oesophageal stenting can be used as a temporizing measure. The mortality rate is high at ~60% (range 40-80%).
-
1. Chavez P, Messerli FH, Casso Dominguez A et-al. Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports. Open Heart. 2015;2 (1): e000257. doi:10.1136/openhrt-2015-000257 - Free text at pubmed - Pubmed citation
-
2. Shroff GS, Guirguis MS, Ferguson EC et-al. CT imaging of complications of catheter ablation for atrial fibrillation. Clin Radiol. 2014;69 (1): 96-102. doi:10.1016/j.crad.2013.08.018 - Pubmed citation
-
3. D'Avila A, Ptaszek LM, Yu PB et-al. Images in cardiovascular medicine. Left atrial-esophageal fistula after pulmonary vein isolation: a cautionary tale. Circulation. 2007;115 (17): e432-3. doi:10.1161/CIRCULATIONAHA.106.680181 - Pubmed citation
-
4. Miyamoto S, Mashimo Y, Horimatsu T et-al. Cerebral air embolism caused by chemoradiotherapy for esophageal cancer. J. Clin. Oncol. 2012;30 (25): e237-8. doi:10.1200/JCO.2012.41.6156 - Pubmed citation
-
5. Lemola K, Sne5. ider M, Desjardins B, Case I, Han J, Good E, Tamirisa K, Tsemo A, Chugh A, Bogun F, Pelosi F Jr, Kazerooni E, Morady F, Oral H. Computed tomographic analysis of the anatomy of the left atrium and the esophagus: implications for left atrial catheter ablation. Circulation. 2004 Dec 14;110(24):3655-60. Epub 2004 Nov 29.
-
6. Williams TL, Parikh DR, Hopkin JR et-al. Teaching NeuroImages: cerebral air embolism secondary to atrial-esophageal fistula. Neurology. 2009;72 (12): e54-5. doi:10.1212/01.wnl.0000345003.44413.5b - Pubmed citation
-
7. Preis O, Digumarthy SR, Wright CD, Shepard JA. J Thorac Imaging. 2007 Aug;22(3):283-285. Atrioesophageal fistula after catheter pulmonary venous ablation for atrial fibrillation: imaging features. Preis O1, Digumarthy SR, Wright CD, Shepard JA.
-
8. Malamis AP1, Kirshenbaum KJ, Nadimpalli S. CT radiographic findings: atrio-esophageal fistula after transcatheter percutaneous ablation of atrial fibrillation. J Thorac Imaging. 2007 May;22(2):188-91.
Promoted articles (advertising)
Unable to process the form. Check for errors and try again.