Atrio-oesofageale fistels na ablatie bij voorkamerfibrillatie: diagnose en aanpak voor de eerste lijn

Abstract

How to diagnose and manage atrio-esophageal fistulas occurring after atrial fibrillation ablation procedures? An atrio-esophageal fistula (AEF) is a rare complication occurring after an ablation procedure for atrial fibrillation, associated with a high mortality. The aim of this study is to provide a practical flowchart for first-line healthcare professionals on the diagnostics and management of these patients. A literature search was performed, resulting in the inclusion of 100 AEF cases after atrial fibrillation ablation procedures (85 reports). The documentation on these 100 patients was analyzed to compose the flowchart. All patients presented within 2 months after the ablation procedure (23 ± 11 days). Neurologic symptoms (75%), fever (73%) and both symptoms (57%) occurred in the majority. A CT scan of the chest was performed in 78% of the cases. In 30% of the patients, an AEF was observed. In other patients, the diagnosis was suspected based on air in the left cardiac circulation or the mediastinum. An esophagogastroscopy resulted in an infaust deterioration in 14/26 of the cases. In total, 41 patients received esophageal surgery (76% survival) versus 9 with only stenting (22% survival). In 27 patients, the diagnosis or treatment was not obtained in time. An AEF should be suspected in patients presenting with fever or neurological symptoms after a recent ablation procedure. CT scans of the chest and head can support the diagnosis. Once diagnosed, one should proceed to emergency surgery to prevent further complications. An esophagogastroscopy should be avoided. The authors hope to provide a practical management guide, allowing an earlier diagnosis, a faster treatment and thus an improved survival in these patients.