TITLE:
Successful Anesthetic Management for Surgical Repair of Atrio-Esophageal Fistula Following Radiofrequency Ablation for Atrial Fibrillation
AUTHORS:
Atsushi Yasuda, Paul H. Alfille, Lisa T. Wollman-Kliman
KEYWORDS:
Atrial Fibrillation; Radiofrequency Ablation; Complication; Atrio-Esophageal Fistula; Anesthetic Management
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.8,
October
14,
2013
ABSTRACT:
Introduction: Atrio-esophageal fistula is a rare but often fatal complication of
radiofrequency ablation for atrial fibrillation. Here we report a successful
case in anesthetic management of surgical repair of atrio-esophageal fistula. Case Report: The patient was a 56-year-old man status post radiofrequency
ablation for atrial fibrillation one month before presenting with fever and
symptoms and signs of cerebral emboli. He was diagnosed as having
atrio-esophageal fistula, which required emergent surgical repair. In the
operating room, rapid sequence induction was performed with avoidance of
positive pressure ventilation before securing airway. Double lumen tube was
used for lung isolation for left thoracotomy. Upon exploration, a small fistula
was identified. Both atrial and esophageal defects were ligated and an intercostal
muscle flap was placed. The patient’s heart rhythm was atrial flutter/atrial
fibrillation with marginal hemodynamics during the procedure, but cardioversion
was delayed until the fistula was repaired and no remaining air, blood clot or
gastric content in the heart was confirmed by epicardial ultrasound. The
patient tolerated the surgery and was transferred to ICU, intubated and
ventilated. He recovered from surgery and was transferred to a rehabilitation
hospital with residual expressive aphasia. Conclusion: We had a successful case in anesthetic management for surgical repair of
atrio-esophageal fistula by preventing massive bleeding as well as multiple air
embolization through the fistula.