Fatal atrial oesophageal fistula following pulmonary vein isolation: an unresolved safety issue

Abstract

Atrial fibrillation is a common cardiac arrhythmia that is associated with high morbidity and mortality. Radiofrequency ablation with extensive circumferential pulmonary vein isolation has been recognised as the most commonly employed ablation method to treat recurrent atrial fibrillation that is refractory to drug therapy. Atrial-oesophageal fistula is one of the most devastating complications following this procedure and has implications for intensive care clinicians. We report the clinical course of a patient with an extensive history of recurrent, drug-refractory atrial fibrillation who developed atrial-oesophageal fistula three weeks after pulmonary vein isolation, suffered a series of complications as a consequence, and eventually died.