Medeiros De Vasconcelos José Tarcisio, Filho Silas Dos Santos Galvão, Atié Jacob, Maciel Washington, De Souza Olga Ferreira, Saad Eduardo Benchimol, Kalil Carlos Antonio, De Castro Mendonça Rodrigo, Araujo Nilson, Pisani Cristiano F, Scanavacca Mauricio Ibrahim
Clinica de Ritmologia Cardiaca do Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil.
Clínica São Vicente and Hospital Universitário da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Europace. 2017 Feb 1;19(2):250-258. doi: 10.1093/europace/euw284.
Atrial-oesophageal fistula is a serious complication related to ablation of atrial fibrillation. As its occurrence is rare, there is a great lack of information about their mechanisms, incidence, presentations, and treatment. The objective of this manuscript is to present a series of cases of atrial-oesophageal fistula in Brazil, focusing on incidence, clinical presentation, and follow-up.
This is a retrospective multicentre registry of atrial-oesophageal fistula cases that occurred in eight Brazilian centres from 2003 to 2015. Ten cases (0.113%) of atrial-oesophageal fistula were reported in 8863 ablation procedures in the period. Most of the subjects were male (70%) with age 59.6 ± 9.3 years. Eight centres were reference units in atrial fibrillation ablation with an experience over than 200 procedures at the time of fistula occurrence. Oesophageal temperature monitoring was performed in eight cases using coated sensors in six. The first atrial-oesophageal fistula clinical manifestation was typically fever (in six patients), with a median onset time of 16.5 (12–43) days after ablation. There was a delay of 7.8 ± 3.3 days between the first manifestation and the diagnosis in five patients. The treatment was surgical in six cases, clinical in three and stenting in one. Seven patients died (70%) and two developed permanent neurological sequelae.
Atrial-oesophageal fistula remains a serious complication following AF ablation despite the incorporation of protective measures and increased technical experience of the groups. The high morbidity and mortality despite the treatment indicates the need to develop adequate preventive strategies.
心房-食管瘘是与房颤消融相关的严重并发症。由于其发生率较低，关于其发病机制、发病率、临床表现及治疗的信息极为匮乏。本文的目的是介绍巴西一系列心房-食管瘘病例，重点关注发病率、临床表现及随访情况。
这是一项对2003年至2015年在巴西八个中心发生的心房-食管瘘病例的回顾性多中心登记研究。在此期间，8863例消融手术中共报告了10例（0.113%）心房-食管瘘。大多数患者为男性（70%），年龄为59.6±9.3岁。八个中心是房颤消融的参考单位，在瘘发生时已有超过200例手术经验。八例患者进行了食管温度监测，其中六例使用了涂层传感器。心房-食管瘘的首发临床表现通常为发热（六例患者），消融术后中位发病时间为16.5（12 - 43）天。五例患者首发症状与诊断之间的间隔为7.8±3.3天。六例患者接受了手术治疗，三例接受了保守治疗，一例接受了支架置入治疗。七例患者死亡（70%）,两例出现永久性神经后遗症。
尽管采取了保护措施且各团队技术经验有所增加，但心房-食管瘘仍是房颤消融术后的严重并发症。尽管进行了治疗，但高发病率和死亡率表明需要制定充分的预防策略。
