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Atrioesophageal fistula—a dangerous complication of catheter ablation for atrial fibrillation

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 578–579 (2007)Cite this article

Radiofrequency catheter ablation is an effective strategy for treating patients with recurrent atrial fibrillation (AF), and is included in guidelines supported by the ACC, AHA and European Society of Cardiology.1 Despite the increasing number of such procedures performed worldwide, radiofrequency ablation remains complex, and has prompted specialists to discuss many controversial aspects and complications of the therapy in two recent consensus statements.2,3 Left atrioesophageal fistula is one such complication addressed in these documents, and we feel that it deserves special attention because of its unusual clinical presentation and severe consequences.

In December 2003 we were surprised by a fatal case of atrioesophageal fistula in a patient who had undergone radiofrequency catheter ablation for AF at our institution 3 weeks earlier.4 We were unaware of this complication at that time, and initially considered it to be an isolated incident. Two other cases of atrioesophageal fistula were reported in the literature at about the same time, however, with both occurring at experienced institutions.5 In addition, an investigation involving volunteer reporting at anonymous institutions identified nine fatal cases between January 2004 and December 2005, all following ablation procedures that had been performed in experienced centers.6 The true prevalence of this complication is still unknown: current reports suggest that it is in the range 0.05–1.5%.2,3,4,5,7,8

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References

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Authors and Affiliations

  1. M Scanavacca is an Assistant Professor and Supervisor of the Electrophysiology Laboratory, D Hachul is an Assistant Professor, and E Sosa is a Professor and Director of the Arrhythmias unit, at the Heart Institute of São Paulo University Medical School, São Paulo, Brazil.,

    Mauricio Scanavacca, Denise Hachul & Eduardo Sosa

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  1. Mauricio Scanavacca
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  2. Denise Hachul
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  3. Eduardo Sosa
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Correspondence to Mauricio Scanavacca.

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Scanavacca, M., Hachul, D. & Sosa, E. Atrioesophageal fistula—a dangerous complication of catheter ablation for atrial fibrillation. Nat Rev Cardiol 4, 578–579 (2007). https://doi.org/10.1038/ncpcardio1010

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