PMC:6019327 / 460609-462318 JSONTXT

{"project":"2_test","denotations":[{"id":"28506916-26380098-45815054","span":{"begin":555,"end":559},"obj":"26380098"},{"id":"28506916-26380098-45815054","span":{"begin":555,"end":559},"obj":"26380098"},{"id":"28506916-20102433-45815055","span":{"begin":613,"end":617},"obj":"20102433"},{"id":"28506916-20102433-45815055","span":{"begin":613,"end":617},"obj":"20102433"},{"id":"28506916-26380098-45815056","span":{"begin":618,"end":622},"obj":"26380098"},{"id":"28506916-26380098-45815056","span":{"begin":618,"end":622},"obj":"26380098"},{"id":"T64385","span":{"begin":555,"end":559},"obj":"26380098"},{"id":"T12132","span":{"begin":555,"end":559},"obj":"26380098"},{"id":"T30962","span":{"begin":613,"end":617},"obj":"20102433"},{"id":"T44247","span":{"begin":613,"end":617},"obj":"20102433"},{"id":"T59269","span":{"begin":618,"end":622},"obj":"26380098"},{"id":"T34159","span":{"begin":618,"end":622},"obj":"26380098"},{"id":"T16009","span":{"begin":555,"end":559},"obj":"26380098"},{"id":"T60153","span":{"begin":555,"end":559},"obj":"26380098"},{"id":"T48345","span":{"begin":613,"end":617},"obj":"20102433"},{"id":"T79554","span":{"begin":613,"end":617},"obj":"20102433"},{"id":"T34996","span":{"begin":618,"end":622},"obj":"26380098"},{"id":"T24464","span":{"begin":618,"end":622},"obj":"26380098"}],"text":"The clinical manifestations of an AEF usually present 2–4 weeks after the ablation procedure. The most common symptoms are fever and recurrent neurological events (septic emboli), but patients can present with septic shock, esopha-geal bleeding, or death. A recent case series of 53 patients who developed an AEF following AF ablation reported a mean interval between the procedure and presentation of 20 ± 12 days, ranging from 2 to 60 days. In this series, fever was the most common presenting symptom, followed by neurological deficits and hematemesis.1176 The preferred diagnostic modality is a chest CT scan.1169,1176 It is important to recognize that a normal chest CT scan does not rule out the presence of an AEF with 100% sensitivity. Ongoing vigilance and evaluation are important if the clinical suspicion is high. Although a barium swallow can detect a fistula, its sensitivity is low. IV contrast is much more likely to demonstrate a lesion passing from the esophagus to the mediastinum, the pericardium, or the LA. If an AEF is suspected, endoscopy with air insufflation should be avoided, given that insufflation of the esophagus with air can result in a large air embolus, producing stroke or death. An alternative strategy, which some members of the writing group employ and which appears to have lower risk, is to use CO2 instead of air for insufflation in this setting. If CO2 were introduced into the LA, there would be little adverse consequence. The early recognition of an AEF can be missed due to the low awareness of this rare complication. It is important for patients to be educated as to warning signs and to contact their AF ablation center should any suggestive symptoms develop."}