Atrio-esophageal fistula
Updates to Article Attributes
Atrio-oesophageal fistulas are rare pathological connections between the left atrium and the oesophagus.
Clinical presentation
The presentation is non-specific. Patients may complain of fever, malaise, and/or dysphagia, or present with neurological symptoms 3.
Pathology
The chief cause of atrial-oesophageal fistulas is iatrogenic in the setting of cardiac ablation procedures (e.g. PVI ablation), although, theoretically, many mediastinal pathology or procedure could potentially cause a fistula.
Complications
Radiographic features
CT
CT is the modality of choice and may reveal communication between the left atrium and the oesophagus which can be evidenced by IV contrast present in the oesophagus.
Other possible features include:
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 oesophageal resection of the fistulous area. Oesophageal stenting can be used as a temporizing measure. The mortality rate is high at ~60% (range 40-80%).
-<p><strong>Atrio-oesophageal fistulas</strong> are rare pathological connections between the <a href="/articles/left-atrium-1">left atrium</a> and the <a href="/articles/oesophagus">oesophagus</a>. </p><h4>Clinical presentation</h4><p>The presentation is non-specific. Patients may complain of fever, malaise, and/or <a href="/articles/dysphagia">dysphagia</a>, or present with neurological symptoms <sup>3</sup>. </p><h4>Pathology</h4><p>The chief cause of atrial-oesophageal fistulas is iatrogenic in the setting of cardiac ablation procedures, although, theoretically, many mediastinal pathology or procedure could potentially cause a fistula.</p><h5>Complications</h5><ul>-<li><a href="/articles/air-embolism">air embolism</a></li>-<li><a href="/articles/pneumomediastinum">pneumomediastinum</a></li>-<li><a href="/articles/pericardial-effusion">pericardial effusion</a></li>-<li>infection </li>- +<p><strong>Atrio-oesophageal fistulas</strong> are rare pathological connections between the <a href="/articles/left-atrium-1">left atrium</a> and the <a href="/articles/oesophagus">oesophagus</a>. </p><h4>Clinical presentation</h4><p>The presentation is non-specific. Patients may complain of fever, malaise, and/or <a href="/articles/dysphagia">dysphagia</a>, or present with neurological symptoms <sup>3</sup>. </p><h4>Pathology</h4><p>The chief cause of atrial-oesophageal fistulas is iatrogenic in the setting of cardiac ablation procedures (e.g. <a href="/articles/pulmonary-vein-isolation-ablation" title="PVI ablation">PVI ablation</a>), although, theoretically, many mediastinal pathology or procedure could potentially cause a fistula.</p><h5>Complications</h5><ul>
- +<li><p><a href="/articles/air-embolism">air embolism</a></p></li>
- +<li><p><a href="/articles/pneumomediastinum">pneumomediastinum</a></p></li>
- +<li><p><a href="/articles/pericardial-effusion">pericardial effusion</a></p></li>
- +<li><p>infection </p></li>
-<li><a href="/articles/pericardial-effusion">pericardial effusion</a></li>-<li><a href="/articles/pneumomediastinum">pneumomediastinum</a></li>-<li>gas within the chambers of the heart</li>-<li>posterior left atrial wall thickening</li>-<li>posterior mediastinal <a href="/articles/fat-stranding">fat stranding</a>-</li>-<li>narrow irregular ulcerated <a href="/articles/pulmonary-veins">pulmonary vein</a>-</li>- +<li><p><a href="/articles/pericardial-effusion">pericardial effusion</a></p></li>
- +<li><p><a href="/articles/pneumomediastinum">pneumomediastinum</a></p></li>
- +<li><p>gas within the chambers of the heart</p></li>
- +<li><p>posterior left atrial wall thickening</p></li>
- +<li><p>posterior mediastinal <a href="/articles/fat-stranding">fat stranding</a></p></li>
- +<li><p>narrow irregular ulcerated <a href="/articles/pulmonary-veins">pulmonary vein</a></p></li>
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