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Atrial - Esophageal Fistula Rare Complication After Ablation

Before their deaths, nine with complication had fever, leukocytosis and neurologic abnormalities

MONDAY, April 24 (HealthDay News) -- Physicians should be alert for atrial-esophageal fistulas, a rare but potentially fatal complication that can develop in patients who have undergone catheter ablation for atrial fibrillation, according to a study published in the April 18 issue of the Annals of Internal Medicine.

Jennifer E. Cummings, M.D., of The Cleveland Clinic in Ohio, and colleagues conducted a retrospective case study of nine patients with atrial-esophageal fistulas after atrial fibrillation ablation.

The researchers found that the patients presented a mean of 12.3 days after their procedures with non-specific symptoms that included fever, general malaise, leukocytosis and neurologic abnormalities often consistent with multiple embolic strokes. All nine of the patients died. The researchers also found that all patients had presented to a physician, but that only four of them had received correct diagnoses before their deaths.

"Physicians must have a high index of suspicion for this complication in patients recently undergoing catheter ablation and presenting with the constellation of symptoms described in this report," write the authors, noting that their study is limited because few doctors reported cases. "Awareness of this potential complication is particularly important for primary care physicians and emergency department physicians, because rapid diagnosis and appropriate triage of affected patients may be crucial to survival. Early surgical intervention seems to be the best opportunity to improve survival."

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