Customer of mine suffers ablation fistula - nearly dies

A customer of mine (at my Natural Food Store) here in Charlotte NC had an ablation last April 27. In late May he was feeling horrible, fever, shaking chills etc.......from the ER he was helocoptered to Duke.....where they told his family "if he survives he will have brain damage" ....he was at Duke for 5 weeks........he survived! they sewed muscle from another area to the esophagus , they gave him a 5% chance!....he could not eat or drink for 2 weeks.
He is on amioderone......no idea why......but he has been in rhythm since the ablation.......his EP choice I have not heard of here in Charlotte.......he went in to it blindly, not knowing anything about the procedure and it's risks.........I'll bet most agree to an ablation without any real knowledge......they just trust the MD...........

Tom

Horror story.

That's pretty rare nowadays.

Geezz...as I had another bout of Afib this morning that lasted 6 hours, I began revisiting the idea of just getting an ablation and getting on with this. These kinds of reports always give me pause.....hopefully your friend will be well again.

What IS a fistula, anyway?

~ Barb

I think the key here is to ensure that you are dealing with an expert in the field of ablation surgery. It is CRITICAL and I can attest to the damage that a QUACK, unconcerned, full of himself doctor can achieve in short order. It put me on life support for two weeks (out of 6 weeks in hospital in 2009) and almost killed ME. It put me on the SLOW track to recovery from aFib and did damage to me but not of this nature. And the quack continues to practice and hurt and possibly kill folks. Nobody interested.

YOU MUST ADVOCATE FOR YOURSELF! Knowledge is power and you must determine the best surgeon for ablation before forging ahead with one.

I know that I am in the hands of two of the best in the world now and am quite content and at peace with them, knowing that whatever route we choose I will receive only the best of care in the most professional of hands.

A fistula... essentially an opening between two areas of the body that is not intended. I had a quack dentist that tried to extract a wisdom tooth in his office without the proper education and equipment and created a fistula from my root canal into my sinus. That was 20 years ago and I still suffer the ill effects today although certainly no as bad as 20 years ago. Long story. A fistula is something one does not want to have and there are many and varied kinds of fistulas that can occur throughout the body, naturally and through surgical intervention.

I am glad to hear that your friend survived... and wish him (and his family) the best in terms of recovery and dealing with the frustration, etc.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

Barbara,

An esophageal fistula is when an EP who isn't paying attention uses too much heat for too long when ablating around that area of the back wall of the left Atrium directly adjacent and in front of the esophagus which is located directly behind the LA in very close proximity.

It is extremely rare these days .. its always been very rare but it likely the worst outcome possible from an ablation. Don't let that scare you away ., just insure you go to an elite operator with a ton of experience and your odds of such a complication will be a good deal less than simply falling out of your bed from a bad dream and dying on the floor. Picking the very best EP you can find is your one and only job, so do that part right and a fistula will not be something to lose even on second of sleep over.

Take care,
Shannon

Facing my first ablation on Dec. 12, this possibility concerns me greatly. I will bring it up during the pre-op discussion. The EP who will do my ablation does the procedure 4 days a week, so lets hope he will be careful in there.

This story is scary, and especially so since he was made aware of the fistula so many weeks after the procedure. I would have thought, if a fistula occurred, they'd know right away, and take steps to treat it right then and there.

My stepmother had an ablation which resulted in a fistula and that essentaillhy ruined her life. She was unable to take care of herself the rest of her life (over 8 years), although she was older when she had the ablation (I think late 70's). This ablation also occurred in the late 90's, so maybe it was still a new and more risky procedure back then (I comfort myself with that). But it makes it scary when someone you knew personally had such a bad experience with it.

Diane - I'm very sorry to learn of your sad, dreadful family experience. Keep in mind, as Shannon has posted many times, procedures have improved greatly. It's also critical to choose a highly-experienced EP who also uses the monitoring equipment that helps prevent the overheating of tissue that causes the fistula. Another factor that may not have been considered back then, but certainly must be by now is that in the elderly, all tissue starts to thin. If an extreme amount of heat was applied in the burning process, the tissue continues to heat even after the energy is turned off and in the past, that was reported as the most common source of esophageal fistulas. Thin tissue would be all the more vulnerable. Certainly by now and with all the newer equipment along with so many more EPs not only doing more ablations but also continuing to learn by the mistakes of others, the occurrence of such an event has diminished greatly. If and when the time comes that you would decide to proceed with an ablation, remember the advice Shannon and many of us offer... choose the most experienced EP with the best track record known at a well-known heart center.

Jackie

Mary and Diane,

Again the fistula issue is truly a very rare event, especially now, but was even so in the relative 'old days' of ablations. And decent docs worth their salt should for sure be hyper-aware and use every precaution that this does not happen so dont fret too much about this issue.

Using an irrigated catheter is a big help in keeping temps down while allowing transmural lesions.

And Diane, it is more common for any fistula signs and symptoms to develop in the first several days up to two weeks typically post ablation rather than show up right away due to the often slow ulceration that can develop between the back wall of the left atrium and the esophagus from too much sustained heat too close to the esophagus.

Shannon