Atrioesophageal fistula (AEF) is a rare and serious complication of atrial fibrillation (AF) ablation, defined as a connection between the atrium and the lumen of the esophagus. 1 AEF has an incidence of 0.1% to 0.25% 2 and a mortality over 50%. 3 AEF can occur with any of the available AF ablation modalities, including radiofrequency ablation (RFA), cryoballoon ablation, high-intensity focused ultrasound ablation, and surgical ablation. 4 The clinical presentation of an AEF is usually seen 2–6 weeks post ablation. The most common symptoms are fever and neurological deficits caused by intracranial embolism of air, saliva, and bacteria. 2 The most useful diagnostic method is via a chest computed tomography (CT) with intravenous (IV) contrast.

Once AEF is identified, the recommended approach is to consider immediate surgical intervention. The literature shows that, based on the management chosen, the mortality rates are 96% with medical management alone, 100% with stent placement, and 33% with surgical repair. 5