Case Report
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World J Gastroenterol. Jun 7, 2013; 19(21): 3352-3353
Published online Jun 7, 2013. doi: 10.3748/wjg.v19.i21.3352
Endoscopic management of an esophagopericardial fistula after radiofrequency ablation for atrial fibrillation
Lucille Quénéhervé, Nicolas Musquer, Franck Léauté, Emmanuel Coron
Lucille Quénéhervé, Nicolas Musquer, Emmanuel Coron, Digestive Diseases Institute, University Hospital of Nantes, 44035 Nantes, France
Franck Léauté, Department of Radiology, University Hospital of Nantes, 44035 Nantes, France
Author contributions: All authors contributed to conception and design of this case report; Quénéhervé L and Musquer N wrote the draft and the final manuscript; all authors revised and approved the final version of the manuscript.
Correspondence to: Emmanuel Coron, MD, PhD, Digestive Diseases Institute, University Hospital of Nantes, 1 Place Alexis Ricordeau, 44035 Nantes, France. emmanuel.coron@chu-nantes.fr
Telephone: +33-2-40083097 Fax: +33-2-40083154
Received: January 4, 2013
Revised: February 19, 2013
Accepted: March 6, 2013
Published online: June 7, 2013
Processing time: 151 Days and 6.9 Hours
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.