症例は 66 歳,男性.持続性心房細動に対し経皮的カテーテルアブレーションを施行された.施行後 15 日目 に吐血を主訴として来院し,上部消化管内視鏡検査にて食道潰瘍と診断された.約 1 カ月間の絶食治療の 後,経口摂取を再開したが,再開後 4 日目に多発性脳梗塞を発症し,同日大量吐血からショック,心肺停止 となった.カテーテルアブレーションに合併した左房食道瘻と診断し,心肺蘇生後緊急手術を施行した.胸 骨正中切開にてアプローチし,体外循環を用い心停止下に左房後壁の瘻孔および食道穿孔部を直接縫合閉鎖 したが,開心術後 3 日目に低心拍出量症候群と多臓器不全にて死亡した.本疾患は稀な合併症であるが,発 症すれば致命的な病態となるため発生予防が重要である.また発症した場合には速やかな外科的治療が必要 と思われる.日心外会誌 42 巻 2 号:155-158(2013) キーワード:経皮的カテーテルアブレーション,左房食道瘻,合併症,吐血 A 66-year-old man underwent percutaneous transcatheter ablation of the

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... dium to treat chronic atrial fibrillation. Fifteen days after the procedure, he visited our hospital with a chief complaint of hematemesis. At that time, upper gastrointestinal endoscopy led to a diagnosis of esophageal ulcer. Oral food intake was suspended for approximately 1 month. Subsequently, 4 days after resumption of oral intake, he developed multiple cerebral infarcts. Moreover, massive hematemesis occurred, with resultant shock and cardiopulmonary arrest. At this point, a definitive diagnosis of left atrio-esophageal fistula resulting from the injury relating to the transcatheter ablation was made. Cardiopulmonary resuscitation was carried out, followed by emergency surgery. The operation was performed via median sternotomy and was done under cardiac arrest using complete extracorporeal bypass, and the fistula in the posterior left atrial wall and the middle esophagus were directly sutured for closure. Unfortunately, 3 days after this open heart surgery, the patient died from low cardiac output syndrome and multiple organ failure. Although rare, this complication may be fatal when it develops then its prevention is important. Once atrio-esophageal fistula develops after percutaneous transcatheter ablation, immediate surgical intervention seems essential. Jpn. J. Cardiovasc. Surg. 42 : 155-158(2013)