Successful Anesthetic Management for Surgical Repair of Atrio-Esophageal Fistula Following Radiofrequency Ablation for Atrial Fibrillation
Successful Anesthetic Management for Surgical Repair of Atrio-Esophageal Fistula Following Radiofrequency Ablation for Atrial Fibrillation作者机构：Department of Anesthesia Critical Care and Pain Medicine Massachusetts General Hospital Boston USA.
出 版 物：《Open Journal of Anesthesiology》 (麻醉学期刊（英文）)
年 卷 期：2013年第3卷第8期
页 面：353-355页
学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学]
主 题：Atrial Fibrillation Radiofrequency Ablation Complication Atrio-Esophageal Fistula Anesthetic Management
摘 要：Introduction: Atrio-esophageal fistula is a rare but often fatal complication of radiofrequency ablation for atrial fibrillation. Here we report a successful case in anesthetic management of surgical repair of atrio-esophageal fistula. Case Report: The patient was a 56-year-old man status post radiofrequency ablation for atrial fibrillation one month before presenting with fever and symptoms and signs of cerebral emboli. He was diagnosed as having atrio-esophageal fistula, which required emergent surgical repair. In the operating room, rapid sequence induction was performed with avoidance of positive pressure ventilation before securing airway. Double lumen tube was used for lung isolation for left thoracotomy. Upon exploration, a small fistula was identified. Both atrial and esophageal defects were ligated and an intercostal muscle flap was placed. The patient’s heart rhythm was atrial flutter/atrial fibrillation with marginal hemodynamics during the procedure, but cardioversion was delayed until the fistula was repaired and no remaining air, blood clot or gastric content in the heart was confirmed by epicardial ultrasound. The patient tolerated the surgery and was transferred to ICU, intubated and ventilated. He recovered from surgery and was transferred to a rehabilitation hospital with residual expressive aphasia. Conclusion: We had a successful case in anesthetic management for surgical repair of atrio-esophageal fistula by preventing massive bleeding as well as multiple air embolization through the fistula.
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