Ischemic Esophageal Ulceration That Developed After an Early Endoscopic Surveillance in a Patient Receiving Catheter Ablation for Atrial Fibrillation

An atrioesophageal fistula is a rare but lethal complication that develops a week to several weeks after the pulmonary vein isolation for atrial fibrillation.1 Because the thermal injury resulting from radiofrequency energy application peaks within a few days,2 the ischemic or gastric reflux injury that progresses during the following weeks was assumed to play a pivotal role in the delayed development of this complication.1 However, no report has ever precisely described the nature of the ischemic injury. Here, we report a case of an esophageal ulceration that developed after an early endoscopic surveillance that was assumed to be the result of the ischemic injury observed in patients receiving extensive pulmonary vein isolation for atrial fibrillation.A 55-year-old man with a symptomatic paroxysmal atrial fibrillation underwent extensive pulmonary vein isolation under conscious sedation. After a simultaneous pulmonary vein angiogram and esophagogram (Figure 1A), the extensive pulmonary vein isolation was carried out with an open-irrigation-tip catheter (ThermoCool, Biosense, Webster, Diamond Bar, CA). A maximum of 15 to 20 W with a duration of 20 …