Li Chang-Yi, Li Song-Nan, Jiang Chen-Yang, Fu Hua, Liang Ming, Wang Zu-Lu, Zhong Jing-Quan, Zhou Xian-Hui, Wu Qi, Chang Dong, Wang Yan, Zhou Gen-Qing, Liu Wen-Shao, Song Wei, Sang Cai-Hua, Long De-Yong, Du Xin, Dong Jian-Zeng, Ma Chang-Sheng
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Pacing Clin Electrophysiol. 2020 Jul;43(7):627-632. doi: 10.1111/pace.13973. Epub 2020 Jun 11.
Atrioesophageal fistula (AEF) is a rare but devastating complication with high mortality post atrial fibrillation (AF) ablation. The purpose of current study was to determine the epidemiology, clinical features, pathogenesis, and management of AEF after AF ablation.
Patients with diagnosed AEF were included and retrospectively analyzed according to the registry of 11 centers in China from January 2010 to December 2019. A total of 16 AEF cases were identified from 44 794 patients who received a left atrial ablation procedure (0.035% per procedure). The interval from procedure to clinical onset of AEF averaged 18.3 days (3-39 days). The fever ranked the most common symptom, occurred in 14 of the 16 cases, followed by neurological deficits (n = 11), chest pain (n = 5), and hematemesis (n = 4). Patients undergoing surgical repair had a better prognosis compared to those receiving nonsurgical management ([4 of 8] 50.0% vs [8 of 8] 100%, P < .05) with an overall mortality rate of 75.0%.
AEF is highly characterized by varied manifestations. Early diagnosis and urgent surgical repair are vital to those patients and associated with improved survival rates.
心房食管瘘（AEF）是心房颤动（AF）消融术后一种罕见但极具破坏性的并发症，死亡率很高。本研究的目的是确定AF消融术后AEF的流行病学、临床特征、发病机制及治疗方法。
纳入已确诊AEF的患者，并根据中国11个中心2010年1月至2019年12月的登记资料进行回顾性分析。在44794例行左心房消融手术的患者中共识别出16例AEF病例（每次手术发生率为0.035%）。从手术到AEF临床发病的间隔时间平均为18.3天（3 - 39天）。发热是最常见症状，16例中有14例出现，其次是神经功能缺损（n = 11）、胸痛（n = 5）和呕血（n = 4）。与接受非手术治疗的患者相比，接受手术修复的患者预后更好（[8例中的4例]50.0% 对 [8例中的8例]100%，P < 0.05），总死亡率为75.0%。
AEF具有多种表现形式。早期诊断和紧急手术修复对这些患者至关重要，且与生存率提高相关。
