Work

Pericardial-Esophageal Fistula After Ethanol and Radiofrequency Ablation of Atrial Fibrillation

Year: 2025

Type: article

Abstract: BACKGROUND: Pericardial esophageal fistula (PEF) is an extremely rare but life-threatening complication of atrial fibrillation ablation. CASE SUMMARY: A 69-year-old man underwent radiofrequency ablation with ethanol infusion into the vein of Marshall. Nine days later, he developed fever, cough, and chest tightness, unresponsive to self-administered antibiotics. Chest computed tomography (CT) revealed pericardial effusion with pneumopericardium, suspicious for PEF. Urgent pericardiocentesis and surgical repair were performed, and the patient was discharged after 4 months. DISCUSSION: Combined ethanol infusion and posterior-wall radiofrequency ablation may increase the risk of esophageal and pericardial injury. Early recognition is challenging; chest CT and timely surgery are critical for survival. TAKE-HOME MESSAGES: Maintain high suspicion for PEF after atrial fibrillation ablation. Prompt CT diagnosis and urgent surgery are key to improved outcomes.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106156

Authors: Zhongwei Jiang, Zhihui Hou, Cheng Wang

Institutions: Jiangsu Province Hospital, Nanjing Medical University

Language: English

Topic: Atrial Fibrillation Management and Outcomes

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850