Temporary esophageal stenting allows healing of esophageal perforations following atrial fibrillation ablation procedures

T. Jared Bunch, Jennifer Nelson, Tom Foley, Scott Allison, Brian G. Crandall, Jeffrey S. Osborn, J. Peter Weiss, Jeffrey L. Anderson, Peter Nielsen, Lars Anderson, Donald L. Lappe, John D. Day

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Background: Left atrial catheter ablation (LACA) has emerged as a successful method to eliminate atrial fibrillation (AF). Recent reports have described atrio-esophageal fistulas, often resulting in death, from this procedure. Temporary esophageal stenting is an established therapy for malignant esophageal disease. We describe the first case of successful temporary esophageal stenting for an esophageal perforation following LACA. Case: A 48-year-old man with symptomatic drug refractory lone AF underwent an uneventful LACA. Fifty-nine ablations with an 8-mm tip ablation catheter (30 seconds, 70 Watts, 55°C), as guided by 3-D NavX™ mapping, were performed in the left atrium to isolate the pulmonary veins as well as a left atrial flutter and roof ablation line. In addition, complex atrial electrograms in AF and sites of vagal innervation were ablated. Two weeks later, he presented with sub-sternal chest pain, fever, and dysphagia. A chest CT showed a 3-mm esophageal perforation at the level of the left atrium with mediastinal soiling and no pericardial effusion. An urgent upper endoscopy with placement of a PolyFlex removable esophageal stent to seal off the esophago-mediastinal fistula was performed. After 3 weeks of i.v. antibiotics, naso-jejunal tube feedings, and esophageal stenting, the perforation resolved and the stent was removed. Over 18 months of follow-up, there have been no other complications, and he has returned to a physically active life and remains free from AF on previously ineffective anti-arrhythmic drugs. Conclusion: Early diagnosis of esophageal perforations following LACA may allow temporary esophageal stenting with successful esophageal healing. Prompt chest CT scans with oral and i.v. contrast should be considered in any patient with sub-sternal chest pain or dysphagia following LACA.

Original languageEnglish (US)
Pages (from-to)435-439
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume17
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

Fingerprint

Esophageal Perforation
Catheter Ablation
Atrial Fibrillation
Deglutition Disorders
Heart Atria
Chest Pain
Stents
Thorax
Esophageal Diseases
Cardiac Electrophysiologic Techniques
Esophageal Fistula
Atrial Flutter
Pericardial Effusion
Pulmonary Veins
Anti-Arrhythmia Agents
Enteral Nutrition
Pharmaceutical Preparations
Endoscopy
Fistula
Early Diagnosis

Keywords

  • Atrial fibrillation ablation
  • Biophysics of catheter ablation
  • Complications of catheter ablation
  • Esophageal perforation
  • Esophageal stenting

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Temporary esophageal stenting allows healing of esophageal perforations following atrial fibrillation ablation procedures. / Bunch, T. Jared; Nelson, Jennifer; Foley, Tom; Allison, Scott; Crandall, Brian G.; Osborn, Jeffrey S.; Weiss, J. Peter; Anderson, Jeffrey L.; Nielsen, Peter; Anderson, Lars; Lappe, Donald L.; Day, John D.

In: Journal of Cardiovascular Electrophysiology, Vol. 17, No. 4, 04.2006, p. 435-439.

Research output: Contribution to journalArticle

Bunch, TJ, Nelson, J, Foley, T, Allison, S, Crandall, BG, Osborn, JS, Weiss, JP, Anderson, JL, Nielsen, P, Anderson, L, Lappe, DL & Day, JD 2006, 'Temporary esophageal stenting allows healing of esophageal perforations following atrial fibrillation ablation procedures', Journal of Cardiovascular Electrophysiology, vol. 17, no. 4, pp. 435-439. https://doi.org/10.1111/j.1540-8167.2006.00464.x
Bunch, T. Jared ; Nelson, Jennifer ; Foley, Tom ; Allison, Scott ; Crandall, Brian G. ; Osborn, Jeffrey S. ; Weiss, J. Peter ; Anderson, Jeffrey L. ; Nielsen, Peter ; Anderson, Lars ; Lappe, Donald L. ; Day, John D. / Temporary esophageal stenting allows healing of esophageal perforations following atrial fibrillation ablation procedures. In: Journal of Cardiovascular Electrophysiology. 2006 ; Vol. 17, No. 4. pp. 435-439.
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AU - Bunch, T. Jared

AU - Nelson, Jennifer

AU - Foley, Tom

AU - Allison, Scott

AU - Crandall, Brian G.

AU - Osborn, Jeffrey S.

AU - Weiss, J. Peter

AU - Anderson, Jeffrey L.

AU - Nielsen, Peter

AU - Anderson, Lars

AU - Lappe, Donald L.

AU - Day, John D.

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N2 - Background: Left atrial catheter ablation (LACA) has emerged as a successful method to eliminate atrial fibrillation (AF). Recent reports have described atrio-esophageal fistulas, often resulting in death, from this procedure. Temporary esophageal stenting is an established therapy for malignant esophageal disease. We describe the first case of successful temporary esophageal stenting for an esophageal perforation following LACA. Case: A 48-year-old man with symptomatic drug refractory lone AF underwent an uneventful LACA. Fifty-nine ablations with an 8-mm tip ablation catheter (30 seconds, 70 Watts, 55°C), as guided by 3-D NavX™ mapping, were performed in the left atrium to isolate the pulmonary veins as well as a left atrial flutter and roof ablation line. In addition, complex atrial electrograms in AF and sites of vagal innervation were ablated. Two weeks later, he presented with sub-sternal chest pain, fever, and dysphagia. A chest CT showed a 3-mm esophageal perforation at the level of the left atrium with mediastinal soiling and no pericardial effusion. An urgent upper endoscopy with placement of a PolyFlex removable esophageal stent to seal off the esophago-mediastinal fistula was performed. After 3 weeks of i.v. antibiotics, naso-jejunal tube feedings, and esophageal stenting, the perforation resolved and the stent was removed. Over 18 months of follow-up, there have been no other complications, and he has returned to a physically active life and remains free from AF on previously ineffective anti-arrhythmic drugs. Conclusion: Early diagnosis of esophageal perforations following LACA may allow temporary esophageal stenting with successful esophageal healing. Prompt chest CT scans with oral and i.v. contrast should be considered in any patient with sub-sternal chest pain or dysphagia following LACA.

AB - Background: Left atrial catheter ablation (LACA) has emerged as a successful method to eliminate atrial fibrillation (AF). Recent reports have described atrio-esophageal fistulas, often resulting in death, from this procedure. Temporary esophageal stenting is an established therapy for malignant esophageal disease. We describe the first case of successful temporary esophageal stenting for an esophageal perforation following LACA. Case: A 48-year-old man with symptomatic drug refractory lone AF underwent an uneventful LACA. Fifty-nine ablations with an 8-mm tip ablation catheter (30 seconds, 70 Watts, 55°C), as guided by 3-D NavX™ mapping, were performed in the left atrium to isolate the pulmonary veins as well as a left atrial flutter and roof ablation line. In addition, complex atrial electrograms in AF and sites of vagal innervation were ablated. Two weeks later, he presented with sub-sternal chest pain, fever, and dysphagia. A chest CT showed a 3-mm esophageal perforation at the level of the left atrium with mediastinal soiling and no pericardial effusion. An urgent upper endoscopy with placement of a PolyFlex removable esophageal stent to seal off the esophago-mediastinal fistula was performed. After 3 weeks of i.v. antibiotics, naso-jejunal tube feedings, and esophageal stenting, the perforation resolved and the stent was removed. Over 18 months of follow-up, there have been no other complications, and he has returned to a physically active life and remains free from AF on previously ineffective anti-arrhythmic drugs. Conclusion: Early diagnosis of esophageal perforations following LACA may allow temporary esophageal stenting with successful esophageal healing. Prompt chest CT scans with oral and i.v. contrast should be considered in any patient with sub-sternal chest pain or dysphagia following LACA.

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KW - Biophysics of catheter ablation

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KW - Esophageal stenting

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