Pericardial-esophageal fistula complicating cryoballoon ablation for refractory atrial fibrillation

Atrial fibrillation affects an estimated 2.7–6.1 million people in the United States and accounts for more than 750,000 hospitalizations per year.1 Pulmonary vein isolation (PVI) has been well established as the most effective ablation treatment available for patients with symptomatic and medication-refractory atrial fibrillation.2 Previously, radiofrequency (RF) ablation was the mainstay for PVI. However, this was not without complications, which have been well documented,3,4 the most feared complication being atrioesophageal fistula formation, which carries an estimated 0.01%–0.25% risk and an estimated mortality of 60%–75%.