Abstract 19143: Atrio-Esophageal Fistula After Atrial Fibrillation Ablation: A Pooled Analysis of 33 Cases

Abstract

Introduction: Atrio-esophageal fistula (AEF) is one of the most devastating complications of percutaneous atrial fibrillation (AF) ablation. Despite its high case fatality, clinical predictors, presentation and outcomes of the complication are not well studied due to the rarity of the complication. We intended to perform a pooled analysis of all cases of atrio-esophageal fistula reported in the literature. Methods: We reviewed Medline for all cases of AEF as a complication after percutaneous AF ablation. Patient demographics, procedural characteristics, clinical presentation, management and outcomes all these patients were collected and analyzed. Predictors of mortality were assessed using univariate analyses. Results: A total of 33 cases of AEF post-AF ablation were reported in the literature till May of 2013. Mean age of the patients was 54 ± 13 years of which 30 (91%) were males. Majority of them had non-paroxysmal AF (18; 66%). Mean time to presentation after the procedure was 21 ±14 days. Most patients presented with fever (26; 79%). Other common presenting symptoms were chest pain (12; 36%), stroke 8 (26%), seizures (6; 19%) and hematemesis 4 (13%). Of the 33 patients 15 (45%) patients died during the immediate follow-up directly related to the AEF. In 22 (66%) patients surgery was attempted as the primary mode of therapy, 4 (18%) patients had a stent placed and the rest underwent palliative care. In univariate analyses, the only predictor of mortality was age. Patients who died were older than those who survived (61 ±13 vs 49 ±13; p = 0.004). Conclusion: Atrio-esophageal fistula is a devastating complication of AF ablation with a case fatality rate of 45%. Older patients are more likely to die of the complication.