Han Hui-Chen, Ha Francis J, Sanders Prashanthan, Spencer Ryan, Teh Andrew W, O'Donnell David, Farouque Omar, Lim Han S
From the Austin Health, Melbourne, Victoria, Australia (H.-C.H., F.J.H., R.S., A.W.T., D.O., O.F., H.S.L.); University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., O.F., H.S.L.); Centre for Heart Rhythm Disorders (CHRD), South Australia Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital (P.S.); and Northern Health, Melbourne, Victoria, Australia (H.S.L.).
Circ Arrhythm Electrophysiol. 2017 Nov;10(11). doi: 10.1161/CIRCEP.117.005579.
Percutaneous or surgical ablation are increasingly used worldwide in the management of atrial fibrillation. The development of atrioesophageal fistula (AEF) is among the most serious and lethal complications of atrial fibrillation ablation. We sought to characterize the clinical presentation, procedural characteristics, diagnostic investigations, and treatment outcomes of all reported cases of AEF.
Electronic searches were conducted in PubMed and Embase for English scientific literature articles. Out of 628 references, 120 cases of AEF were identified using various ablation modalities. Clinical presentation occurred between 0 and 60 days postablation (median 21 days). Fever (73%), neurological (72%), gastrointestinal (41%), and cardiac (40%) symptoms were the commonest presentations. Computed tomography of the chest was the commonest mode of diagnosis (68%), although 7 cases required repeat testing. Overall mortality was 55%, with significantly reduced mortality in patients undergoing surgical repair (33%) compared with endoscopic treatment (65%) and conservative management (97%) (adjusted odds ratio, 24.9; <0.01, compared with surgery). Multivariable predictors of mortality include presentation with neurological symptoms (adjusted odds ratio, 16.0; <0.001) and gastrointestinal bleed (adjusted odds ratio, 4.2; =0.047).
AEF complicating atrial fibrillation ablation is associated with a high mortality. Clinicians should have a high suspicion for the development of AEF in patients presenting with infective, neurological, gastrointestinal, or cardiac symptoms within 2 months of an atrial fibrillation ablation. Investigation by contrast computed tomography of the chest with consideration of repeat testing can lead to prompt diagnosis. Surgical intervention is associated with improved survival rates.
在全球范围内，经皮或手术消融越来越多地用于心房颤动的治疗。心房食管瘘（AEF）的发生是心房颤动消融最严重且致命的并发症之一。我们试图对所有已报道的AEF病例的临床表现、手术特征、诊断检查及治疗结果进行描述。
在PubMed和Embase中进行电子检索，查找英文科学文献文章。在628篇参考文献中，通过各种消融方式确定了120例AEF病例。临床表现出现在消融术后0至60天（中位时间为21天）。发热（73%）、神经症状（72%）、胃肠道症状（41%）和心脏症状（40%）是最常见的表现。胸部计算机断层扫描是最常见的诊断方式（68%），不过有7例需要重复检查。总体死亡率为55%，与内镜治疗（65%）和保守治疗（97%）相比，接受手术修复的患者死亡率显著降低（33%）（调整后的优势比为24.9；与手术相比，P<0.01）。死亡率的多变量预测因素包括出现神经症状（调整后的优势比为16.0；P<0.001）和胃肠道出血（调整后的优势比为4.2；P=0.047）。
并发于心房颤动消融的AEF与高死亡率相关。对于在心房颤动消融后2个月内出现感染、神经、胃肠道或心脏症状的患者，临床医生应高度怀疑AEF的发生。通过胸部对比计算机断层扫描进行检查并考虑重复检查可实现及时诊断。手术干预与生存率提高相关。
