Multiple Coronary Arteries to Left Atrial Fistulae: An Uncommon Complication of Radiofrequency Ablation for Atrial Fibrillation.

A 64-year-old man had undergone catheter radiofrequency ablation (RFA) 3 times in the previous 3 years because of recurrent symptomatic atrial fibrillation. Five months after the third RFA procedure, unusually colored Doppler flows that drained into the left atrium (LA) were newly identified. Coronary computed tomographic angiography indicated the presence of multiple small fistulae reaching from the right and left circumflex coronary arteries to the LA, and this was confirmed using coronary angiography. This case shows that the multiple RFA procedures induced coronary neovascularization and fistulae formation after ischemic injuries to the LA.