Brief communication: atrial-esophageal fistulas after radiofrequency ablation.

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.