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- Received September 6, 2012
- Accepted September 11, 2012
- Published online March 19, 2013.
A 50-year-old woman with chronic kidney disease and rheumatoid arthritis underwent radiofrequency catheter ablation for symptomatic persistent atrial fibrillation. The patient sought treatment at the emergency room after 4 weeks with minor hematemesis. Esophagogastroduodenoscopy revealed a thrombus along the esophageal wall (A). Computed tomography scans of the chest demonstrated abnormal contouring of the left atrial wall, concerning for atrioesophageal fistula and pleural effusions (B and C, red arrow). Emergency cardiac and esophageal surgery was performed, during which the left atrium was repaired via a pericardial patch. The esophageal ulcer was resected and the esophagus was anastomosed in end-to-end fashion. The thrombus (black arrow) can be seen bridging the gap between the left atrium (being retracted with forceps) and the esophagus (being retracted with yellow Penrose drains) (D, Online Video 1). Gross examination of the resected tissue revealed the large esophageal lesion responsible for the fistula (E). The patient is now 1 year past surgical repair and free of atrial fibrillation.
Although fortunately uncommon, this complication should be suspected in patients with symptoms of esophageal reflux, fever, or neurological symptoms after left atrial ablation. Such patients often may warrant noninvasive imaging before considerations for direct endoscopy.
- Received September 6, 2012.
- Accepted September 11, 2012.
- American College of Cardiology Foundation