Atrioesophageal Fistula Following Radiofrequency Catheter Ablation of Atrial Fibrillation

Rev Cardiovasc Med. 2017;18(3):115-122. doi: 10.3909/ricm0883.


Atrioesophageal fistula (AEF) is a rare but catastrophic complication of catheter ablation of atrial fibrillation (AF), with an incidence of 0.03% to 1.5% per year. We report two cases and review the epidemiology, clinical features, pathogenesis, and management of AEF after AF ablation. The principal clinical features of AEF include fever, hematemesis, and neurologic deficits within 2 months after ablation. The close proximity of the esophagus to the posterior left atrial wall is considered responsible for esophageal injury during ablation and the eventual development of AEF. Prophylactic proton pump inhibitors, esophageal temperature monitoring, visualization of the esophagus during catheter ablation, esophageal protection devices, esophageal cooling, and avoidance of energy delivery in close proximity to the esophagus are some techniques to prevent esophageal injury. Eliminating esophageal injury during AF ablation is of utmost importance in preventing AEF. A high index of suspicion and early intervention are necessary to prevent fatal outcomes. Early surgical repair is the mainstay of treatment.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Action Potentials
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / adverse effects*
  • Electrophysiologic Techniques, Cardiac
  • Endoscopy, Digestive System
  • Esophageal Fistula / diagnosis
  • Esophageal Fistula / etiology*
  • Esophageal Fistula / surgery
  • Female
  • Heart Diseases / diagnosis
  • Heart Diseases / etiology*
  • Heart Diseases / surgery
  • Heart Rate
  • Humans
  • Male
  • Middle Aged
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ulcer / diagnosis
  • Ulcer / etiology*
  • Ulcer / surgery