Successful Anesthetic Management for Surgical Repair of Atrio-Esophageal Fistula Following Radiofrequency Ablation for Atrial FibrillationReport as inadecuate




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Introduction: Atrio-esophageal fistula is a rare but often fatal complication ofradiofrequency ablation for atrial fibrillation. Here we report a successfulcase in anesthetic management of surgical repair of atrio-esophageal fistula. Case Report: The patient was a 56-year-old man status post radiofrequencyablation for atrial fibrillation one month before presenting with fever andsymptoms and signs of cerebral emboli. He was diagnosed as havingatrio-esophageal fistula, which required emergent surgical repair. In theoperating room, rapid sequence induction was performed with avoidance ofpositive pressure ventilation before securing airway. Double lumen tube wasused for lung isolation for left thoracotomy. Upon exploration, a small fistulawas identified. Both atrial and esophageal defects were ligated and an intercostalmuscle flap was placed. The patient’s heart rhythm was atrial flutter-atrialfibrillation with marginal hemodynamics during the procedure, but cardioversionwas delayed until the fistula was repaired and no remaining air, blood clot orgastric content in the heart was confirmed by epicardial ultrasound. Thepatient tolerated the surgery and was transferred to ICU, intubated andventilated. He recovered from surgery and was transferred to a rehabilitationhospital with residual expressive aphasia. Conclusion: We had a successful case in anesthetic management for surgical repair ofatrio-esophageal fistula by preventing massive bleeding as well as multiple airembolization through the fistula.

KEYWORDS

Atrial Fibrillation; Radiofrequency Ablation; Complication; Atrio-Esophageal Fistula; Anesthetic Management

Cite this paper

A. Yasuda, P. Alfille and L. Wollman-Kliman -Successful Anesthetic Management for Surgical Repair of Atrio-Esophageal Fistula Following Radiofrequency Ablation for Atrial Fibrillation,- Open Journal of Anesthesiology, Vol. 3 No. 8, 2013, pp. 353-355. doi: 10.4236-ojanes.2013.38075.





Author: Atsushi Yasuda, Paul H. Alfille, Lisa T. Wollman-Kliman

Source: http://www.scirp.org/



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