Domenico G Della Rocca1, Michele Magnocavallo1,2, Veronica N Natale3, Carola Gianni1, Sanghamitra Mohanty1, Chintan Trivedi1, Carlo Lavalle3, Giovanni B Forleo4, Nicola Tarantino5, Jorge Romero5, Xiadong Zhang5, Mohamed Bassiouny1, Amin Al-Ahmad1, J David Burkhardt1, G Joseph Gallinghouse1, Javier E Sanchez1, Rodney P Horton1, Luigi Di Biase1,5,6, Andrea Natale1,7,8. 1. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX, 78705, USA. 2. Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. 3. Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University, Baltimore, MD, USA. 4. Department of Cardiology, Azienda Ospedaliera-Universitaria "Luigi Sacco", Milano, Italy. 5. Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. 6. Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy. 7. Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA. 8. Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Abstract
BACKGROUND: Atrioesophageal fistula (AEF) is a worrisome complication of atrial fibrillation (AF) ablation. Its clinical manifestations and time course are unpredictable and may contribute to diagnostic and treatment delays. We conducted a systematic review of all available cases of AEF, aiming at characterizing clinical presentation, time course, diagnostic pitfalls, and outcomes. METHODS: The digital search retrieved 150 studies containing 257 cases, 238 (92.6%) of which with a confirmed diagnosis of AEF and 19 (7.4%) of pericardio-esophageal fistula. RESULTS: The median time from ablation to symptom onset was 21 days [IQR: 11-28]. Neurological abnormalities were documented in 75% of patients. Compared to patients seen by a specialist, those evaluated at a walk-in clinic or community hospital had a significantly greater delay between symptom onset and hospital admission [median: 2.5day (IQR:1-8) versus 1day (IQR:1-5); p-value=0.03]. Overall, 198 patients underwent a chest scan [(computed tomography (CT): 192 patients and magnetic resonance imaging (MRI): 6 patients], 48 (24.2%; 46 CT and 2 MRI) of whom had normal/unremarkable findings. Time from hospital admission to diagnostic confirmation was significantly longer in patients with a first normal/unremarkable chest scan (p<0.001). Overall mortality rate was 59.3% and 26.0% survivors had residual neurological deficits at the time of discharge. CONCLUSIONS: Since healthcare professionals of any specialty might be involved in treating AEF patients, awareness of the clinical manifestations, diagnostic pitfalls, and time course, as well as an early contact with the treating electrophysiologist for a coordinated interdisciplinary medical effort are pivotal to prevent diagnostic delays and reduce mortality. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
BACKGROUND:Atrioesophageal fistula (AEF) is a worrisome complication of atrial fibrillation (AF) ablation. Its clinical manifestations and time course are unpredictable and may contribute to diagnostic and treatment delays. We conducted a systematic review of all available cases of AEF, aiming at characterizing clinical presentation, time course, diagnostic pitfalls, and outcomes. METHODS: The digital search retrieved 150 studies containing 257 cases, 238 (92.6%) of which with a confirmed diagnosis of AEF and 19 (7.4%) of pericardio-esophageal fistula. RESULTS: The median time from ablation to symptom onset was 21 days [IQR: 11-28]. Neurological abnormalities were documented in 75% of patients. Compared to patients seen by a specialist, those evaluated at a walk-in clinic or community hospital had a significantly greater delay between symptom onset and hospital admission [median: 2.5day (IQR:1-8) versus 1day (IQR:1-5); p-value=0.03]. Overall, 198 patients underwent a chest scan [(computed tomography (CT): 192 patients and magnetic resonance imaging (MRI): 6 patients], 48 (24.2%; 46 CT and 2 MRI) of whom had normal/unremarkable findings. Time from hospital admission to diagnostic confirmation was significantly longer in patients with a first normal/unremarkable chest scan (p<0.001). Overall mortality rate was 59.3% and 26.0% survivors had residual neurological deficits at the time of discharge. CONCLUSIONS: Since healthcare professionals of any specialty might be involved in treating AEF patients, awareness of the clinical manifestations, diagnostic pitfalls, and time course, as well as an early contact with the treating electrophysiologist for a coordinated interdisciplinary medical effort are pivotal to prevent diagnostic delays and reduce mortality. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Authors: Michele Magnocavallo; Antonio Parlavecchio; Giampaolo Vetta; Carola Gianni; Marco Polselli; Francesco De Vuono; Luigi Pannone; Sanghamitra Mohanty; Filippo Maria Cauti; Rodolfo Caminiti; Vincenzo Miraglia; Cinzia Monaco; Gian-Battista Chierchia; Pietro Rossi; Luigi Di Biase; Stefano Bianchi; Carlo de Asmundis; Andrea Natale; Domenico Giovanni Della Rocca Journal: J Clin Med Date: 2022-09-21 Impact factor: 4.964