Commentary: The rising storm of atrioesophageal fistulae after catheter ablation for atrial fibrillation

Abstract

In this case report, Gibney and colleagues describe the successful management of an atrioesophageal fistula (AEF) that developed as a complication of previous percutaneous ablation for atrial fibrillation. This timely report addresses a rare but highly lethal clinical scenario that all thoracic surgeons will increasingly face in the future. Catheter ablation has recently become a cornerstone of therapy for patients with paroxysmal and chronic atrial fibrillation. Recent large randomized trials, such as the CASTLE-AF and CABANA trials, demonstrating the benefits of catheter ablation for atrial fibrillation are expected to lead to an increased number of atrial fibrillation ablations performed worldwide. As the authors have noted, because the development of AEF is a rare but highly lethal complication of catheter ablation for atrial fibrillation, early recognition of the complication and prompt surgical intervention is imperative. In literature reviews of all reported patients with AEF after catheter ablation for atrial fibrillation, fever and neurologic deficits were the most common presenting symptoms, and the 2012 Heart Rhythm Society consensus statement on catheter and surgical ablation of atrial fibrillation has highlighted these 2 symptoms.