Atrial dysrhythmias due to extrinsic left atrial compression by an esophageal stent

Abstract

Removal of the extrinsic compression force may alleviate arrhythmias by reducing epicardial irritation and/or limiting atrial stretch. Introduction Arrhythmogenesis resulting from extrinsic cardiac compression is a well-observed but poorly understood process. The left atrium has generated the most attention given its proximity to several structures, with scattered case reports describing this phenomenon in relation to esophageal malignancy as well as aortic dilation, hiatal hernia, achalasia, and bronchogenic cysts. Perhaps the best-studied association between mechanical compression of the heart and arrhythmia is pectus excavatum, which is thought to contribute to the development of atrial fibrillation. Although an exact mechanism is unfounded, hypotheses include direct epicardial compression and irritation owing to local inflammation, as in the case of pericarditis; pain and increased sympathetic drive; neural reflexes triggered by distorted esophageal anatomy; and deglutination reflexes, as is hypothesized in swallowing-induced tachyarrhythmia. We present a patient with multiple supraventricular arrhythmias triggered by compression of the left atrium by an indwelling esophageal stent. We are aware of only 1 previous report of atrial fibrillation occurring in the setting of significant left atrial compression from an esophageal stent. To our knowledge, this case is the first demonstrating both atrial fibrillation and atrial tachycardia related to extrinsic left atrial compression, and also the first to demonstrate resolution of these arrhythmias after stent removal.