Wu et al reported a case of an atrio-esophageal-thoracic fistula following radiofrequency ablation performed to control atrial fibrillation. The authors are from Chongqing Medical University, Chongqing Key Laboratory of Forensic Medicine, and Interpol Corps of the Chongqing Public Bureau in Congqing China
Features:
(1) history of radiofrequency ablation for atrial fibrillation
(2) no evidence of pre-existing fistula
(3) development of the fistula after the procedure, with massive hemorrhage
(4) exclusion of other explanations for the fistula
(5) demonstration that the treated area corresponds to the fistula site
The interval between the procedure and the exsanguinating hemorrhage may range from 0 to 30 days.
The differential diagnosis might include foreign body ingestion, nasogastric tube placement or tracheal intubation. Careful dissection and histologic examination is required for the investigation.
A brilliant piece of investigation was the use of scanning electron microscopy with energy dispersion spectroscopy (SEM-EDS). They were able to identify alloys from the radioablation tip (Cr, Cu, Zn, Mn and Ti) at the site of perforation.
