Atrio-esophageal fistula


CT showing anatomic relationship between an enlarged left atrium (LA) and esophagus (ESO): atrium abuts and indents into the anterior wall of the esophagus.
  • Rare but deadly complication of atrial ablation
  • There have been reported cases with various ablation modalities (including radiofrequency ablation, cryoablation, high intensity focused ultrasound, and surgical ablation)
  • Incidence is low (<0.1%) [1]
  • Usually formed between esophagus and left atrium
  • Thought to be related to adverse healing secondary to esophageal injury during the ablation procedure

Clinical Features

  • Most common presenting symptoms:
    • Fever
    • Neurological symptoms (including focal neurological symptoms, seizure, AMS)
    • Gastrointestinal symptoms (including hematemesis, melena, dysphagia, nausea/vomiting)
    • Chest pain
  • Most common time frame to presentation is 2-4 weeks post procedure but can occur up to 2 months post procedure

Differential Diagnosis

  • Sepsis
  • Stroke/TIA
  • GI bleed

Chest pain





Chest CT demonstrating pneumomediastinum after cardiac radiofrequency catheter ablation for refractory atrial fibrillation.
  • CT chest with contrast is the recommended modality, but repeat testing may be needed for eventual diagnosis [2]
  • Endoscopy may be considered, but may be associated an increased risk of clinical deterioration
  • Transthoracic and transesophageal echocardiography have not been found to be highly sensitive


  • Mortality is high in all patients
  • Surgery has the best mortality benefit, followed by endoscopic intervention
  • Nonintervention has the worst outcome


  • Admission
  • Surgery consultation

See Also

External Links


  1. Nair KK, Danon A, Valaparambil A, Koruth JS, Singh SM. Atrioesophageal Fistula: A Review. J Atr Fibrillation. 2015;8(3):1331. Published 2015 Oct 31. doi:10.4022/jafib.1331
  2. Han H-C, Hui-Chen Han From the Austin Health, Ha FJ, et al. Atrioesophageal Fistula. Circulation: Arrhythmia and Electrophysiology. Published November 6, 2017. Accessed December 14, 2020.