An atrioesophageal fistula may rarely develop secondary to esophageal injury occurring during radiofrequency catheter ablation for atrial fibrillation (AF).


Patient selection: radiofrequency catheter ablation of atrial fibrillation


Risk factors:

(1) deep esophageal ulceration following the procedure

(2) failure to have limits on power or duration of radiofrequency applications

(3) operator inexperience

(4) temperature >= 39°C with an intraesophageal temperature probe during the procedure


Onset of symptoms is 1-6 weeks after the procedure


Clinical features may include:

(1) fever

(2) malaise

(3) dysphagia

(4) chest pain

(5) hemoptysis

(6) neurologic symptoms secondary to micro-emboli

(6a) due to air emboli

(6b) due to infective endocarditis


Laboratory findings may include:

(1) variable positive blood cultures (often with oral flora)


Imaging studies may show:

(1) air in the atrium

(2) vegetations on a heart valve

(3) fistula tract


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