Department of Cardiothoracic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Department of Internal Medicine, Section of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
J Cardiovasc Electrophysiol. 2021 May;32(5):1449-1451. doi: 10.1111/jce.15005. Epub 2021 Mar 24.
Radiofrequency ablation (RFA) is an effective treatment modality for atrial fibrillation (AF); however, serious complications can occur. We present the case of a highly morbid consequence, the esophagopericardial fistula (EPF).
A hemodynamically unstable patient with a history of AF and recent RFA presented with chest pain and was found to have pneumopericardium and pericardial effusion. The patient went to the operating room emergently for combined management with surgical pericardial window and endoscopic stent placement.
EPF must be on the differential diagnosis while evaluating patients who develop constitutional symptoms or sudden onset chest pain days or weeks after catheter ablation for AF. Early detection followed by aggressive management with a combined surgical and endoscopic approach may be considered for successful treatment of this type of postablation esophageal perforation if an atrioesophageal fistula is effectively ruled out.
射频消融 (RFA) 是治疗心房颤动 (AF) 的有效方法；然而，可能会发生严重的并发症。我们报告了一例后果非常严重的并发症，即食管-心包瘘 (EPF)。
一名血流动力学不稳定的患者，有 AF 病史和近期 RFA 治疗史，出现胸痛，并被发现有气胸和心包积液。患者紧急转入手术室，联合进行心包开窗术和内镜支架放置术。
在评估因 AF 导管消融术后数天或数周出现全身症状或突发胸痛的患者时，必须考虑 EPF 的鉴别诊断。如果能有效排除房-食管瘘，对于此类消融后食管穿孔，早期发现并采用联合手术和内镜方法积极治疗可能是成功的。
