JTCVS Open (Dec 2024)

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

Journal volume & issue
Vol. 22
pp. 476 – 484

Abstract

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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.

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