Atrial-esophageal fistula after atrial fibrillation ablation: a case report and literature review

BACKGROUND: Atrial-esophageal fistula (AEF) is a rare, but high mortality, complication after catheter ablation. At present, there is no standard treatment for AEF. In this article, we introduce the treatment process of a case diagnosed with AEF and review the latest treatment progress of AEF. CASE DESCRIPTION: A 65-year-old man, who received catheter ablation 2 weeks prior, presented with fever, chills, and loss of consciousness. Blood cultures grew Streptococcus viridans. A computed tomography (CT) scan of the brain showed a large area of left craniocerebral infarction and air emboli in the right lobe. The chest CT demonstrated air between the left atrium and esophagus, as well as pericardial effusions. Gastroscopy showed an esophageal fistula 35 cm away from the incisor teeth. The patient was diagnosed with AEF, sepsis, and cerebral infarction. An urgent surgical operation and supportive treatments were performed after diagnosis. Eventually, he died of sepsis and multiple organ failure 24 days after surgery. CONCLUSIONS: We have reported the treatment process of one case diagnosed with AEF and reviewed the latest treatment progress. AEF is a rare but lethal complication after catheter ablation. At present, austere challenges exist in the diagnosis and treatment of AEF. Repeat chest and head CT/magnetic resonance imaging (MRI) are essential for the identification of abnormal manifestations. In terms of treatment, urgent surgical repair is currently recommended once AEF is diagnosed. More attention should be paid to this complication.