Atrio-esophageal fistula


Posterior view of the position and relation of the esophagus in the cervical region and in the posterior mediastinum.
Layers of the GI track: the mucosa, submucosa, muscularis, and serosa.
Esophagus anatomy and nomenclature based on two systems.
CT showing anatomic relationship between an enlarged left atrium (LA) and esophagus (ESO): atrium abuts and indents into the anterior wall of the esophagus.
  • Rare but deadly complication of atrial ablation
  • There have been reported cases with various ablation modalities (including radiofrequency ablation, cryoablation, high intensity focused ultrasound, and surgical ablation)
  • Incidence is low (<0.1%) [1]
  • Usually formed between esophagus and left atrium
  • Thought to be related to adverse healing secondary to esophageal injury during the ablation procedure

Clinical Features

Differential Diagnosis

Chest pain





Chest CT demonstrating pneumomediastinum after cardiac radiofrequency catheter ablation for refractory atrial fibrillation.
  • CT chest with contrast is the recommended modality, but repeat testing may be needed for eventual diagnosis [2]
  • Endoscopy may be considered, but may be associated an increased risk of clinical deterioration
  • Transthoracic and transesophageal echocardiography have not been found to be highly sensitive


  • Mortality is high in all patients
  • Surgery has the best mortality benefit, followed by endoscopic intervention
  • Nonintervention has the worst outcome


  • Admission
  • Surgery consultation

See Also

External Links


  1. Nair KK, Danon A, Valaparambil A, Koruth JS, Singh SM. Atrioesophageal Fistula: A Review. J Atr Fibrillation. 2015;8(3):1331. Published 2015 Oct 31. doi:10.4022/jafib.1331
  2. Han H-C, Hui-Chen Han From the Austin Health, Ha FJ, et al. Atrioesophageal Fistula. Circulation: Arrhythmia and Electrophysiology. Published November 6, 2017. Accessed December 14, 2020.