title: Brief communication: atrial-esophageal fistulas after radiofrequency ablation.
abstract: 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.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Institutions where cardiologists performed atrial fibrillation ablation procedures.
  
  
  METHODS
  9 patients with atrial-esophageal fistulas after atrial fibrillation ablation.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Cummings
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: Walid I
authors.initials: WI
authors.lastname: Saliba
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Fethi
authors.initials: F
authors.lastname: Kilikaslan
authors.forename: Eduardo
authors.initials: E
authors.lastname: Saad
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004937:Esophageal Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D005402:Fistula / Q000000981:diagnostic imaging / Q000209:etiology*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed