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Esophageal Perforation Secondary to Radiofrequency Catheter Ablation for Atrial Fibrillation

James X. Liu and Maria C. Shiau

Radiofrequency catheter ablation of pulmonary veins is generally a safe procedure used in patients with atrial fibrillation. We report a case of a 67-year old woman who suffered esophageal perforation following radiofrequency catheter ablation. Salient symptoms, such as dysphagia, severe chest pain, palpitations, and malaise, as well as the radiological findings of pneumopericardium and esophageal perforation were consistent with the presence of an atrioesophageal fistula. This extremely rare complication warrants immediate surgical intervention. Atrio-esophageal fistula is best diagnosed by thoracic CT with contrast, and may be prevented during the procedure by careful esophageal temperature monitoring and reduction of radiofrequency energy.