Revision 12 for 'Atrial-esophageal fistula'

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Atrio-esophageal fistula

Atrial-esophageal fistulas are rare pathological connections between the left atrium and the esophagus

Clinical presentation

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. 


Radiographic features


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:

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%).

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