Atrio-Esophageal Fistula After Atrial Fibrillation Ablation Under Optimal Esophageal Temperature Monitoring. Case Report

Atrio-esophageal fistula (AEF) is a rare but fatal complication that can occur after radiofrequency ablation (RFA) as well as with cryoballoon technique for atrial fibrillation. While most AEFs involve obvious esophageal lesions, AEFs without apparent esophageal lesions are rare. Herein, we report a rare case of AEF without any obvious esophageal lesions. A 78-year-old man, with a medical history of percutaneous RFA for atrial fibrillation under luminal esophageal temperature monitoring 1 month beforehand, presented with complaints of fever, vomiting, and tarry stools. Computed tomography demonstrated extraesophageal air and pneumocephalus. Therefore, we diagnosed the patient with AEF and treated him with cardiac surgery and antibiotics. Postoperative esophagogastroduodenoscopy revealed no obvious esophageal lesion. Thus, we determined that AEFs can occur despite RFA being performed under the optimal luminal esophageal temperature, and even without an obvious esophageal lesion.