American Journal of Case Reports is ranked the World leading among journals dedicated to publishing clinical case reports. AJCR is indexed in Web of Science, PubMed/ PMC, Scopus

(1) CiteScore (Impact Factor - like by Scopus, Elsevier) is the number of citations received by a journal in one year to documents published in the three previous years, divided by the number of documents indexed in Scopus published in those same three years.

(2) SNIP (Source Normalized Impact per Paper) measures a source’s contextual citation impact by weighting citations based on the total number of citations in a subject field. It helps you make a direct comparison of sources in different subject fields. SNIP takes into account the characteristics of the source's subject field, which is the set of documents citing that source.

(3) SJR is weighted by the prestige of a journal. Subject field, quality, and reputation of the journal have a direct effect on the value of a citation. SJR assigns relative scores to all of the sources in a citation network. Its methodology is inspired by the Google PageRank algorithm, in that not all citations are equal. A source transfers its own 'prestige', or status, to another source through the act of citing it. A citation from a source with a relatively high SJR is worth more than a citation from a source with a lower SJR.

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Clinical case reports are an invaluable first-hand source of evidence in medicine and a tool most often used in practice to exchange information and generate a more expanded search for evidence. In addition to the “evidence of what happened”, single or multiple cases are an important basis for further and more advanced research on diagnosis, treatment effectiveness, causes and outcomes of disease. However limited their conclusions may be, case reports remain a fundamental component of medicine, contributing greatly to the advancement of health care. In today's ever-expanding Evidence-Based Medicine, case reporting require a well-defined focus, content, and structure.

Presently, only a fraction of case reports is useful for clinical decision-making and bedside-decision oriented research. Therefore, the aim of the Journal is to gather case reports across medical disciplines, thereby integrating interdisciplinary, international medical knowledge.

American Journal of Case Reports is ranked the World leading among journals dedicated to publishing clinical case reports. AJCR is indexed in Web of Science, PubMed/ PMC, Scopus

Table of Content Volume 20, 2019

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Published: 2019-04-20

Atrial-Esophageal Fistula After Catheter Ablation: Diagnosing and Managing a Rare Complication of a Common Procedure

Robby Singh, Elise J. Landa, Christian Machado

(Department of Cardiology, Providence Hospital, Michigan State University, Detroit, USA)

Am J Case Rep 2019; 20:557-561

DOI: 10.12659/AJCR.913620

BACKGROUND: Atrial fibrillation is considered the most common cardiac arrhythmias in the United States with rate and rhythm control strategies traditionally used for management. If patients are intolerant to class I or class III anti-arrhythmic medications, catheter ablation may be used as a rhythm control strategy. As catheter ablation becomes more commonplace, so too do the procedure-related complications, which include tamponade, total arterio-venous fistula, pulmonary vein stenosis, and atrial-esophageal fistula.
CASE REPORT: A 67-year-old male underwent catheter ablation for atrial fibrillation and subsequently presented with complaints of fever and chills. Initial workup for a source of infection included a computed tomography (CT) scan and transesophageal echocardiogram which did not reveal any abnormalities. Antibiotic therapy was initiated, and multiple CT scans were performed; eventually patient was found to have an atrial-esophageal fistula, secondary to thermal injury. The patient underwent thoracotomy and full thickness necrosis of the posterior left atrium and pericardium near the base of the left inferior pulmonary vein was visualized, with a roughly nickel sized orifice, which was repaired. The patient had an uneventful recovery and was doing well on follow-up.
CONCLUSIONS: Atrial-esophageal fistula is a rare but lethal complication of atrial fibrillation ablation. While imaging modalities have improved and can detect the condition, they can also yield ambivalent findings which can challenge patient care. It is important for clinicians to maintain a heightened awareness of this complication in post-ablation patients and utilize clinical history and not rely solely on imaging to diagnose and treat this complication.

Keywords: Atrial Fibrillation, delayed diagnosis, Esophageal Fistula, Postoperative Complications

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