Successful endoscopic clipping management of a left atrioesophageal fistula after atrial fibrillation catheter ablation: A case report of a young male patient

Abstract

Atrioesophageal fistula (AEF) is a rare and serious complication of atrial fibrillation (AF) ablation, forming a connection between the atrium and esophagus. A systematic treatment approach for AEF has not been established to date. Herein, we report the case of a young male patient with left AEF after AF catheter ablation, which was successfully treated with the Over-the-Scope Clip (Ovesco Endoscopy AG, Tübingen, Germany) and conservative management. Despite having a double-orifice mitral valve and tricuspid valve, the patient had no symptoms or valve disease. The patient was readmitted three weeks after the procedure owing to fever, hematemesis, consciousness disturbance, hemiplegia, and systemic convulsions. Indigenous bacteria in the oral cavity were detected in blood culture. Magnetic resonance imaging of the brain showed multiple cerebral infarctions. Chest computed tomography showed mediastinal air, suggesting an AEF diagnosis. Subsequently, an endoscopic closure using the Over-the-Scope Clip was performed, leading to a successful recovery and patient discharge on day 87 after admission. This is the first case report of a successful management of AEF after radiofrequency ablation using the Over-the-Scope Clip system. Although surgery is the main treatment for AEFs, we performed nonsurgical management using the clip, demonstrating a potential treatment option for AEF.

Learning objective: Surgical intervention is usually superior to endoscopic intervention and conservative management for treatment of atrioesophageal fistula. To the best of our knowledge, this is the first case to be successfully managed by endoscopic clipping and conservative management.

Keywords: Atrial fibrillation; Atrioesophageal fistulas; Catheter ablation; Over-the-scope clip.