Esophago-Pericardial Fistula Following Ablation of the Atrial Fibrillation Focus

Abstract

In the past 20 years catheter radiofrequency ablation of atrial fibrillation (RAAF) has become a mainstay in the treatment of refractory atrial fibrillation. While generally safe, serious complications following RAAF have been reported. Recent retrospective review of 45,000 cases of catheter ablation reported post-procedure mortality of 0.1 percent. Complication rates of 2%-4% have been previously reported. Percutaneous catheter ablation of electrical triggers near the pulmonary vein ostia is associated with 28% incidence of esophageal erythema and 18% incidence of esophageal ulceration. Patients with atrio-esophageal fistulas and esophageal perforations due to thermal injury can present with non-specific signs and symptoms between 1 and 3 weeks after the procedure and present unusual challenges to the anesthesia provider. Atrio-esophageal fistulas and esophageal perforation have been reported to be lethal complications following RAAF. We present a case of successful treatment of late-presenting esophageal perforation after RAAF.