Brief Communication: Atrial–Esophageal Fistulas after Radiofrequency Ablation

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Abstract
Ablation of atrial fibrillation is generally considered safe and effective. However, atrial–esophageal fistulas have recently been reported as a rare but fatal complication. To describe 9 patients with atrial–esophageal fistulas after ablation for atrial fibrillation. Retrospective case series. Institutions where cardiologists performed atrial fibrillation ablation procedures. 9 patients with atrial–esophageal fistulas after atrial fibrillation ablation. Demographic characteristics, mortality, presenting signs and symptoms, and days to presentation. Patients presented a mean of 12.3 days (range, 10 to 16 days) after their procedures. Nonspecific symptoms included fever, leukocytosis, and neurologic abnormalities. All patients died. Only 4 patients received correct diagnoses before death, although all patients presented to a physician. In 3 patients, surgical repair was attempted. Few physicians reported cases, and only approximate numbers of procedures performed by the physicians are known. Thus, the authors could not estimate the incidence of atrial–esophageal fistulas after ablation. Formation of atrial–esophageal fistulas is a rare but potentially devastating complication of atrial fibrillation ablation. This disorder may have an indolent presentation and may mimic other disease states, such as stroke or sepsis.