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It is estimated that major complications occur in 4%of patients undergoing catheter ablation of atrial fibrillation (AF). One of the most dreaded complications of AF ablation is atrioesophageal fistula (AEF), which results from collateral thermal injury to the esophagus owing to its close relation to the posterior wall of the left atrium. Patients present with fever, sepsis, esophageal symptoms, and/or devastating stroke weeks after the procedure. Although rare, AEF has a high mortality rate even when treated aggressively, suggesting the optimal management approach remains ill-defined. We report the first case of successful surgical outcome of an AEF with direct left atrial repair followed by an esophageal T-tube.

Esophageal T-tube: A novel approach to atrioesophageal fistula repair