Brief communication: atrial-esophageal fistulas after radiofrequency ablation

Ann Intern Med. 2006 Apr 18;144(8):572-4. doi: 10.7326/0003-4819-144-8-200604180-00007.


Background: Ablation of atrial fibrillation is generally considered safe and effective. However, atrial-esophageal fistulas have recently been reported as a rare but fatal complication.

Objective: To describe 9 patients with atrial-esophageal fistulas after ablation for atrial fibrillation.

Design: Retrospective case series.

Setting: Institutions where cardiologists performed atrial fibrillation ablation procedures.

Patients: 9 patients with atrial-esophageal fistulas after atrial fibrillation ablation.

Measurements: Demographic characteristics, mortality, presenting signs and symptoms, and days to presentation.

Results: 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.

Limitations: 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.

Conclusions: 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.

MeSH terms

  • Atrial Fibrillation / surgery*
  • Catheter Ablation / adverse effects*
  • Esophageal Fistula / diagnostic imaging
  • Esophageal Fistula / etiology*
  • Fistula / diagnostic imaging
  • Fistula / etiology*
  • Heart Atria* / diagnostic imaging
  • Humans
  • Imaging, Three-Dimensional
  • Male
  • Retrospective Studies
  • Tomography, X-Ray Computed