Pneumopericardium Following Radiofrequency Ablation for Atrial Fibrillation: Insights into the Natural History of Atrial Esophageal Fistula Formation

Context.— Esophageal fistula formation is one of the most feared complications of radiofrequency catheter ablation. This procedure and its many variations, such as the “maze,” are becoming the mainstream treatment for atrial fibrillation owing to limitations of antiarrhythmic drugs. The incidence of this complication rate has been reported to be from 0.01% to 1%. Objective.— To delineate the importance of using the en bloc Letulle method of dissection for identifying esophageal fistulas for cases with a history of radiofrequency catheter ablation. Design.— Six autopsy cases with a history of radiofrequency catheter ablation for atrial fibrillation were selected from 1736 autopsies performed between 2009 and 2020. Results.— The initial presenting symptoms included neurologic symptoms, chest pains, epigastric discomfort, and sepsis. Transesophageal echocardiogram of 4 cases showed no evidence of thrombus or vegetation, however, 2 cases had evidence of atrial esophageal fistula. The autopsy findings included 5 atrial esophageal fistulas and 1 esophagopericardial fistula. Atrial esophageal fistulas were small and could be detected without difficulty when the en bloc Letulle technique was used and would have been easily missed by the Virchow method. The immediate causes of the deaths were myocardial ischemia, septic emboli to brain and heart, hypovolemic shock secondary to exsanguination, stroke, and coagulopathy. Conclusions.— To date, this is the largest collection of autopsy cases showing esophageal fistula associated with prior radiofrequency catheter ablation. The Letulle dissection method is preferable in this setting.

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344 Does radiofrequency ablation of lone atrial flutter change the natural history of atrial arrhythmia?

EP Europace ◽

10.1016/eupace/7.supplement_1.70 ◽

2005 ◽

Vol 7 (Supplement_1) ◽

pp. 70-70

Author(s):

D. Luria ◽

W.K. Shen ◽

K. Monahan ◽

M. Glikson ◽

D. Packer ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Natural History ◽

Atrial Flutter ◽

Atrial Arrhythmia ◽

History Of

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Abstract 17165: Natural History of Cardiac Function in Patients With Atrial Fibrillation Pre- and Post- Ablation

Circulation ◽

10.1161/circ.142.suppl_3.17165 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Lisa YW Tang ◽

Kendall Ho ◽

Nathaniel Hawkins ◽

Roger Tam ◽

Michael Lim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Natural History ◽

Cardiac Function ◽

Older Patients ◽

Autonomic Function ◽

Pronounced Increase ◽

Success Group ◽

History Of ◽

Future Work

Intro: The natural history of cardiac function in atrial fibrillation (AF) patients undergoing pulmonary vein isolation (PVI) is incompletely described, as are heart rate patterns pre- and post-ablation. Goals: Examine autonomic status pre- and post-ablation using cardiac data (n=346) captured by implanted recorders Methods: Daily records (90-day pre to 365-day post ablation) were analyzed to extract parameters viz. heart rate variability (HRV), daytime heart rate (DHR) and nighttime heart rate (NHR). Analysis of variance was used to assess relationships between covariates (age, sex, etc.) and pre-post changes in parameters. We define "success" as patients who had no recurrence during post-ablation period per guidelines (“failed” otherwise). Results: Prior to ablation, mean DHR, NHR, and HRV were 69±10bpm, 60±9bpm, 122±32msec, respectively. After PVI, there was an immediate increase of ~5bpm in DHR (P<1e-4) and a more pronounced increase of ~11bpm in NHR (P<1e-4). HRV exhibited an immediate post-ablation peak decreasing by ~60msec (P<1e-4), with rapid recalibration over the first 10 post ablation days (increase of 20-25msec). Antiarrhythmic drug-use was a significant factor only in explaining changes in HRV (P=0.0126), while age was a significant factor only for the changes in DHR (P<1e-4). Comparing between subgroups, DHR and NHR were generally higher in the success than the failed group. At baseline, older patients (92 patients were of age>65years) had a significantly lower DHR and NHR than younger patients (117 were of age<56years). These age-based differences were amplified post ablation in DHR and NHR, but not HRV. Conclusions: PVI results in significant and sustained changes in heart rate parameters related to autonomic function. This relationship was observed globally, with the success group having significantly greater rises in DHR and NHR when compared to the failed group. Future work will explore whether these patterns exist in different cohorts.

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