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

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.