Survival of a Patient with an Esophagopericardial Fistula After Catheter Ablation for Atrial Fibrillation: A Case Report and Literature Review

Figure 1:. A: Left: 3D cardiac anatomic map of the LA posterior wall and esophagus, sourced from the anatomic map and ICE images taken from the right atrium, developed using the CARTO® 3 system (Biosense Webster, Diamond Bar, CA, USA). Right: Image fan from the left panel showing the close apposition of the esophagus (green lines) and LA. B: ICE image of the anterior esophageal wall visualized as a hyperechogenic structure running adjacent to the posterior right inferior PV ostium. The right superior PV is further away. Eso: esophageal; RI: right inferior; RS: right superior.

Figure 2:. A: FTI of the 400-g/s ablation lesions at the antrum of the PVs. Left: posterior view; right: anterior view. B: Contact force of the RF ablation lesions on the posterior antral PVs.

Figure 3:. Chest CT scan with oral and intravenous contrast. The arrow indicates the EPF just inferior to the right inferior PV, with extravasation of air and oral contrast into the pericardial space. The left pericardial and pleural drainage tubes are also visible.

Figure 4:. Esophagogram with oral contrast. The arrow indicates the EPF with contrast leak from the esophagus into the pericardial space.

Figure 5:. Illustrative figures of esophageal disease spectrum as a complication of AF ablation. A: Thermal injury resulting in inflammation and shallow mucosal ulcer at the anterior esophagus wall. B: Deep esophageal ulcer. C: EPF. D: LA–esophageal fistula.