The presentation is non-specific. Patients may complain of fever, malaise, dysphagia or present with neurological symptoms 3.
The chief cause of atrial-esophageal fistulas is iatrogenic in the setting of cardiac ablation procedures. Although theoretically many mediastinal pathologies or procedures could also cause a fistula.
CT is the modality of choice, and may reveal a communication between the left atrium and the esophagus which can be evidenced by IV contrast present in the esophagus.
Other possible features include:
- pericardial effusion
- gas within the chambers of the heart
- posterior left atrial wall thickening
- posterior mediastinal fat stranding
- narrow irregular ulcerated pulmonary vein
Treatment and prognosis
The treatment is surgical including resection and repair of the necrotic heart tissue and esophageal resection of fistulous area. Esophageal stenting can be used as a temporizing measure. Mortality rate is high at ~60% (range 40-80%).