Atrioesophageal fistula: a rare cause of brain embolization

Excerpt

Radiofrequency catheter ablation is an important part of the treatment algorithm in patients with highly symptomatic atrial fibrillation. The most common strategy involves isolation of the pulmonary veins alone or in combination with additional ablation. Isolation of the pulmonary veins is based on the application of radiofrequency energy direct to the left atrium (to the ostia of pulmonary veins) to achieve complete electrical isolation of the pulmonary veins with minimal damage to the surrounding tissue. The treatment brings low risk of complications which, however, can be life-threatening—cardiac tamponade (1.31%), pseudoaneurysm, arteriovenous fistula (1.5%), pulmonary vein stenosis (1.3%), and phrenic nerve palsy (0.17%). Rare but serious complication is the formation of atrioesophageal fistula (AEF)—incidence 0.1–0.25%. Mortality exceeds 80%. Only a few dozens of cases have been documented worldwide. …