Wu Shaohui, Zou Guangchen, Sun Yuzhang, Jiang Weifeng, Liu Xu
Department of Cardiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, 241 Huaihai West Road, Shanghai 200052, China.
Department of Nephrology, Johns Hopkins University, Baltimore, USA.
Eur Heart J Case Rep. 2024 Jun 13;8(6):ytae287. doi: 10.1093/ehjcr/ytae287. eCollection 2024 Jun.
Oesophageal fistula is a rare complication of catheter ablation of atrial fibrillation with most fistulas being atrio-oesophageal fistulas, but oesophageal-pericardial fistula can also happen in the absence of atrial perforation.
A 68-year-old male patient presented with chest pain 10 days after catheter ablation of paroxysmal atrial fibrillation. He was discharged after an initial negative workup that included a CT chest without contrast. He later presented again with severe chest pain and fever and was found to have an oesophageal-pericardial fistula. He underwent surgical and endoscopic treatment with good recovery.
Patients with oesophago-pericardial fistulas often have delayed presentation 1-4 weeks after the ablation procedure. Early diagnosis can be challenging. CT with oral and intravenous contrast is often used for diagnosis. Treatment often includes antibiotics, surgical or interventional drainage of infected spaces with oesophageal repair, clipping or stenting. In contrast to atrio-oesophageal fistulas that carry a high mortality rate, mortality for oesophago-pericardial fistulas appears to be much lower.
食管瘘是心房颤动导管消融术的一种罕见并发症，大多数瘘为心房 - 食管瘘，但在无心房穿孔的情况下也可能发生食管 - 心包瘘。
一名68岁男性患者在阵发性心房颤动导管消融术后10天出现胸痛。最初的检查包括胸部非增强CT，结果为阴性，随后他出院了。他后来再次出现严重胸痛和发热，被发现患有食管 - 心包瘘。他接受了手术和内镜治疗，恢复良好。
食管 - 心包瘘患者通常在消融术后1 - 4周出现延迟表现。早期诊断具有挑战性。口服和静脉注射造影剂的CT常用于诊断。治疗通常包括使用抗生素、对感染部位进行手术或介入引流以及食管修复、夹闭或支架置入。与死亡率高的心房 - 食管瘘相比，食管 - 心包瘘的死亡率似乎要低得多。
