This case highlights the potential for a delayed presentation of fatal atrioesophageal fistula following radiofrequency ablation for atrial fibrillation, which may be exacerbated by corticosteroid use.
May warrant extended vigilance for delayed atrioesophageal fistula after AF ablation; leaves open corticosteroid contribution and prevention strategies.
We describe the case of a 61-year-old man with a fatal atrioesophageal fistula following radiofrequency ablation (RFA) for paroxysmal atrial fibrillation (PAF). Esophageal injury was first noted on computed tomography (CT) scan 10 days following RFA. Fistulization occurred 41 days following the procedure. This is a delayed time course in comparison with published reports. The patient declined intervention and we have serial CT imaging documenting the natural progression from ulceration to fistula. Although the patient was on acid suppression, he received 2 courses of corticosteroids, which may have contributed to the progression of his esophageal ulcer.
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Gilcrease et al. (2010) studied this question.
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