Surgical management of atrioesophageal fistula after catheter ablation of atrial fibrillation: A French nationwide studyCentral MessagePerspective
Ludovic Dupautet, MD,
Guillaume Lebreton, MD, PhD,
Gabriel Saiydoun, MD,
Thierry Bourguignon, MD, PhD,
Sébastien Frey, MD,
Christophe Beaufreton, MD, PhD,
Géraud Galvaing, MD, MSc,
Sébastien Cambier, MD, MSc,
Marc Filaire, MD, PhD,
Laura Filaire, MD, MSc
Affiliations
Ludovic Dupautet, MD
Department of Thoracic and Endocrine Surgery, Centre Jean Perrin, Clermont-Ferrand, France
Guillaume Lebreton, MD, PhD
Department of Cardiothoracic Surgical, Hospital La Pitié-Salpêtrière, Paris, France
Gabriel Saiydoun, MD
Department of Cardiothoracic Surgical, Hospital La Pitié-Salpêtrière, Paris, France; Division of Cardiothoracic Surgery and Transplantation, Hospital Henri Mondor, Paris, France
Thierry Bourguignon, MD, PhD
Department of Cardiac Surgery, Tours University Hospital, Tours, France
Sébastien Frey, MD
Department of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
Christophe Beaufreton, MD, PhD
Department of Cardiovascular and Thoracic Surgery, University Hospital, Angers, France
Géraud Galvaing, MD, MSc
Department of Thoracic and Endocrine Surgery, Centre Jean Perrin, Clermont-Ferrand, France
Sébastien Cambier, MD, MSc
Department of Biostatistic, University Hospital Gabriel Montpied, Clermont-Ferrand, France
Marc Filaire, MD, PhD
Department of Thoracic and Endocrine Surgery, Centre Jean Perrin, Clermont-Ferrand, France
Laura Filaire, MD, MSc
Department of Thoracic and Endocrine Surgery, Centre Jean Perrin, Clermont-Ferrand, France; Address for reprints: Laura Filaire, MD, MSc, Department of Thoracic and Endocrine Surgery, Centre Jean-Perrin, 58 rue Montalembert, Clermont-Ferrand, 63000, France.
Objective: The study objective was to assess the efficacity of different surgical strategies for atrioesophageal fistula after catheter ablation of atrial fibrillation. Methods: Between January 2010 and April 2023, all patients with a diagnosis of atrioesophageal fistula or pericardo-esophageal fistula after catheter ablation of atrial fibrillation were analyzed retrospectively from the French database EPITHOR. Patients without surgical management were excluded. Results: Eighteen patients were included, 15 with atrioesophageal fistula and 3 with pericardo-esophageal fistula. Median follow-up was 89.5 days with an overall survival of 50%. Five patients underwent esophageal stenting, 2 as a bridge-to-esophagectomy with 50% of survival and 3 in association with esophagus and left atrial direct repair with 66% survival. Primary esophageal repair with flap coverage was performed in 8 patients with 25% survival, most of them with sepsis and neurological failure. Seven patients had an esophagectomy with 71% survival, only 2 of them having a neurological failure. Among them, 5 patients underwent a restorative surgery and are still alive. Four patients had a retrosternal colon interposition, and 1 patient had an esogastric anastomosis. Risk factors for death were neurological failure (hazard ratio [HR], 4.91, 95% CI, 0.95-25.22; P = .0057) in univariate analysis and sepsis (HR, 6.25, 95% CI, 1.17-33.3; P = .032) in multivariate analysis. Esophagectomy tended to offer a survival benefit (HR, 0.163, 95% CI, 0.019-1.340; P = .092). The use of cardiopulmonary bypass did not significantly impact survival (HR, 1.953, 95% CI, 0.392-9.719; P = .413). Conclusions: Aggressive surgical strategies for managing atrioesophageal fistula are mandatory to offer the best chance of survival.
