Atrio-esophageal fistula

Last revised by Dr Henry Knipe on 09 Aug 2021

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, although, theoretically, many mediastinal pathology or procedure could potentially cause a fistula.

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:

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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Cases and figures

  • Case 1: secondary to RFA
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