Lethal atrioesophageal fistula after pulmonary vein isolation using high-intensity focused ultrasound (HIFU)

d e d 1 f ( s o s n M w t w p a u D c a R j e e p r t r a a R s 5 e s ntroduction eft atrial (LA) catheter ablation has become a successful herapy for patients with atrial fibrillation (AF) and is conidered a class IIa indication by the recently published CC/AHA/ESC guidelines for the management of patients ith this arrhythmia. To minimize the risk of pulmonary ein (PV) stenosis, the currently preferred approach consists f the creation of circular lesions at the PV antrum for PV solation (PVI). As a consequence of the close vicinity of he posterior LA to the esophagus, thermal injury of the sophagus with development of atrioesophageal fistula AEF) has been reported after surgical radiofrequency (RF) blation and, more recently, after percutaneous catheterased interventions. To enhance the safety and efficacy of VI, new energy sources such as cryoablation have been ested, as well as, more recently, high-intensity focused ltrasound (HIFU). Until now, major complications with IFU have been limited to transient or permanent phrenic erve palsy during ablation of the right superior PV RSPV), and one case of right femoral artery pseudoaneuysm was described. We report for the first time the develpment of an AEF after PVI using a HIFU balloon catheter.