Endoscopic management of an esophagopericardial fistula after radiofrequency ablation for atrial fibrillation

Abstract

A case is reported of a 76-year-old man with a past history of atrial fibrillation. A radiofrequency ablation procedure was suggested following several failed cardioversion attempts. However, an esophagopericardial fistula complicated the procedure. This life-threatening complication was successfully managed using both the placement of a covered esophageal stent and surgical pericardial and mediastinal drainage. In fact, no persisting fistula could be detected when the esophageal stent was removed seven weeks later. Atrioesophageal and esophagopericardial fistulas are two of the most severe complications associated with cardiological radiofrequency ablation procedures. They are responsible for majority of the deaths associated with this procedure. Despite the extremely high morbimortality associated with cardiothoracic surgery in such conditions, this treatment is the gold-standard for the management of such complications. This case report emphasizes the importance and efficacy of the endoscopic approach as part of a multidisciplinary management approach to this serious adverse event following radiofrequency ablation for atrial fibrillation.

Keywords: Fistula, Esophageal stent, Radiofrequency ablation, Endoscopy, Complication, Atrial fibrillation

Core tip: We report the successful endoscopic management of an esophagopericardial fistula induced by radiofrequency ablation for atrial fibrillation. Esophagopericardial fistulas are a complication of great significance, being extremely difficult to manage and having a very high mortality rate. In this case, the patient was treated with a fully covered esophageal stent combined with surgical pericardial drainage. It is important to be aware of the increasing incidence of post-radiofrequency esophageal complications for cardiological applications. Furthermore, the possibility to place endoscopic stents as a potential therapeutic option for the occurrence of post-radiofrequency esophageal fistula is extremely important as part of a treatment plan for this complication.