Transthoracic echocardiography-monitored CO(2)-insufflation esophageal endoscopy for diagnosis of Atrioesophageal fistula and prevention of iatrogenic air embolism: a case report

BACKGROUND: Atrioesophageal fistula (AEF) is the most fatal complication associated with catheter ablation for atrial fibrillation and cannot be easily detected when thoracic contrast-enhanced computed tomography (CT) is normal. CASE PRESENTATION: In this report, we described a diagnostic tool for detecting AEF with doubtful chest CT in which we introduced CO(2)-insufflation esophageal endoscopy with transthoracic echocardiography monitoring. Using this modified esophageal endoscopy, AEF was established due to the presence of both esophageal lesions and bubbles into the left atrium. That way, our patient accepted to be operated in time with good clinical prognosis. CONCLUSIONS: This modified esophageal endoscopy is an alternative tool for early detection of AEF when normal or doubtful CT findings present.