E6
Response to Letter to Editor
Outcomes of Atrio-Esophageal Fistula Following Catheter Ablation of Atrial Fibrillation Treated with Surgical Repair versus Esophageal Stenting To the Editor We thank Dr. Danon and his coauthors for their interest in our report and are glad to comment on their concerns.1 All of the patients that received stents were hemodynamically stable and thus were suitable candidates for surgical repair. However, in the participating centers, stent was favored earlier because it was less invasive and because of some case reports suggesting that could work. Later, we switched from stenting to surgery due to the poor results with stents. We did not observe any peri-stenting deterioration related to air-insufflation or stent erosion. We agree with Dr. Danon et al. that the above points are critical to better understand the merits and limitations of stenting. However, we politely differ with their comment that stenting can be considered as a temporary solution before the surgical repair. Rather, we would emphasize the importance of prompt surgical intervention in saving the life of the patient, based on our clinical experience.2
The authors have highlighted the improved outcomes of surgical repair in atrio-esophageal fistula. We are in accordance with it and will like to add that as timing seems to be the decisive factor in the success of the surgical procedure, a high index of suspicion for AEF in patients after AF ablation that can lead to early intervention, is important. Finally, we support the comments made by the authors about the limitations of proton-pump inhibitors and esophageal temperature monitoring in preventing fistula formation during AF ablation and acknowledge the fact that further work is warranted to identify additional protective strategies to minimize esophageal injury. SANGHAMITRA MOHANTY, M.D.∗ ,† and On behalf of the authors
From ∗ St. David’s Medical Center, Austin, Texas; and †College of Natural Sciences, University of Texas at Austin, Texas, USA
References
J Cardiovasc Electrophysiol, Vol. 25, p. E6, September 2014. Address for correspondence: Sanghamitra Mohanty, M.D., St. David’s Medical Center, Austin, TX, USA. Fax: 512-544-8200; E-mail: [email protected] doi: 10.1111/jce.12494
1. Danon A, Elitzur Y, Nair KKM, Singh SM: Letter to the editor: Stenting versus surgery for atrial-esophageal fistula. J Cardiovasc Electrophysiol 2014;25(9):E5. 2. Mohanty S, Di Biase L, Trivedi C, Santangeli P, Bai R, Al-Ahmad A, Horton R, Burkhardt JD, Sanchez JE, Zagrodzky J, Bailey S, Gallinghouse JG, Hranitzky PM, Sun AY, Hao S, Hongo R, Beheiry S, Natale A: Outcomes of surgical repair of atrio-esophageal fistula complicating catheter ablation for atrial fibrillation. Heart Rhythm 2014;11(5_Suppl):S454.
Response to Letter to Editor
Outcomes of Atrio-Esophageal Fistula Following Catheter Ablation of Atrial Fibrillation Treated with Surgical Repair versus Esophageal Stenting To the Editor We thank Dr. Danon and his coauthors for their interest in our report and are glad to comment on their concerns.1 All of the patients that received stents were hemodynamically stable and thus were suitable candidates for surgical repair. However, in the participating centers, stent was favored earlier because it was less invasive and because of some case reports suggesting that could work. Later, we switched from stenting to surgery due to the poor results with stents. We did not observe any peri-stenting deterioration related to air-insufflation or stent erosion. We agree with Dr. Danon et al. that the above points are critical to better understand the merits and limitations of stenting. However, we politely differ with their comment that stenting can be considered as a temporary solution before the surgical repair. Rather, we would emphasize the importance of prompt surgical intervention in saving the life of the patient, based on our clinical experience.2
The authors have highlighted the improved outcomes of surgical repair in atrio-esophageal fistula. We are in accordance with it and will like to add that as timing seems to be the decisive factor in the success of the surgical procedure, a high index of suspicion for AEF in patients after AF ablation that can lead to early intervention, is important. Finally, we support the comments made by the authors about the limitations of proton-pump inhibitors and esophageal temperature monitoring in preventing fistula formation during AF ablation and acknowledge the fact that further work is warranted to identify additional protective strategies to minimize esophageal injury. SANGHAMITRA MOHANTY, M.D.∗ ,† and On behalf of the authors
From ∗ St. David’s Medical Center, Austin, Texas; and †College of Natural Sciences, University of Texas at Austin, Texas, USA
References
J Cardiovasc Electrophysiol, Vol. 25, p. E6, September 2014. Address for correspondence: Sanghamitra Mohanty, M.D., St. David’s Medical Center, Austin, TX, USA. Fax: 512-544-8200; E-mail: [email protected] doi: 10.1111/jce.12494
1. Danon A, Elitzur Y, Nair KKM, Singh SM: Letter to the editor: Stenting versus surgery for atrial-esophageal fistula. J Cardiovasc Electrophysiol 2014;25(9):E5. 2. Mohanty S, Di Biase L, Trivedi C, Santangeli P, Bai R, Al-Ahmad A, Horton R, Burkhardt JD, Sanchez JE, Zagrodzky J, Bailey S, Gallinghouse JG, Hranitzky PM, Sun AY, Hao S, Hongo R, Beheiry S, Natale A: Outcomes of surgical repair of atrio-esophageal fistula complicating catheter ablation for atrial fibrillation. Heart Rhythm 2014;11(5_Suppl):S454.
