title: Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Radiofrequency ablation for atrial fibrillation is becoming widely practiced.
  
  
  RESULTS
  Two patients undergoing circumferential pulmonary vein ablation for atrial fibrillation in different centers developed symptoms compatible with endocarditis 3 to 5 days after the procedure. Their clinical condition deteriorated rapidly, and both suffered multiple gaseous and/or septic embolic events causing cerebral and myocardial damage. One patient survived after emergency cardiac and esophageal surgery; the other died of extensive systemic embolization. An atrio-esophageal fistula was identified in both patients.
  
  
  CONCLUSIONS
  Atrio-esophageal fistulas can occur after catheter ablation in the posterior wall of the left atrium. This diagnosis should be excluded in any patient with symptoms or signs of endocarditis after left atrial ablation, and expeditious cardiac surgery is critical if the diagnosis is confirmed. Lower power and temperature settings for applications of radiofrequency energy along the posterior left atrial wall may prevent further cases of fistula formation.
authors.affiliation: Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. carlo.pappone@hsr.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Santinelli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vicedomini
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Lang
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
authors.forename: Stefano
authors.initials: S
authors.lastname: Benussi
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Robert
authors.initials: R
authors.lastname: Hong
authors.forename: William
authors.initials: W
authors.lastname: Lau
authors.forename: Kirk
authors.initials: K
authors.lastname: Hirata
authors.forename: Neil
authors.initials: N
authors.lastname: Shikuma
authors.forename: Burr
authors.initials: B
authors.lastname: Hall
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004696:Endocarditis / Q000175:diagnosis / Q000209:etiology; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology*; D005402:Fistula / Q000175:diagnosis / Q000209:etiology*; D006325:Heart Atria / Q000293:injuries*; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged