# Peri-Operative Anesthetic Management of Left Atrial-Esophageal Fistula

## TL;DR

This case study describes a rare but life-threatening complication following a heart procedure and emphasizes the importance of careful anesthetic and surgical management.

## Contribution

The paper presents a detailed anesthetic management approach for a rare left atrial-esophageal fistula case.

## Key findings

- A 67-year-old male developed a fatal atrial-esophageal fistula after ablation for atrial fibrillation.
- Anesthetic strategies focused on ensuring oxygenation during one-lung ventilation for fistula repair.
- The case underscores the need for vigilance in managing rare complications of catheter ablation.

## Abstract

Atrial-esophageal fistulas are rare and potentially fatal complications that can occur from radiofrequency ablation for the treatment of atrial fibrillation. Due to the proximity of the right atrium to the esophagus, thermal injuries can involuntarily lead to connections between the heart and esophagus. In this case study, a 67-year-old male developed an atrial-esophageal fistula following atrial fibrillation ablation. After discharge, the patient first presented with melena with a range of complications including aspiration, fever, atrial fibrillation, and neurological symptoms. The fistula was repaired promptly after diagnosis requiring meticulous planning by the anesthesia and surgical teams. The major consideration from anesthesiology was providing adequate oxygenation during one-lung ventilation via continuous positive airway pressure on the non-dependent lung. This case also highlights the need for recognizing and managing potential complications associated with catheter ablation procedures. A thorough understanding of these rare but critical events is essential for optimizing patient outcomes and minimizing mortality rates, and physicians and healthcare professionals must remain vigilant regarding such complications.