Esophageal injury with AF ablation: Rare but potentially devastating

Esophageal injury has remained a nightmare of atrial fibrillation ablation due to potentially catastrophic sequelae. Esophageal perforation after AF ablation can lead to atrio-esophageal fistula, pericardial-esophageal fistula or esophageal perforation without fistula. A recent global survey [1] showed that about 70% of esophageal perforation following AF ablation resulted in atrio-esophageal fistula. They recommend extreme vigil for this rare complication for the first two months after AF ablation and after surgical repair of esophageal perforation. Esophageal perforations do occur despite various esophageal monitoring techniques. Atrial-esophageal fistula has a mortality of nearly eighty percent. But fortunately, it is a very rare complication of AF ablation.


  1. Barbhaiya CR, Kumar S, Guo Y, et al. Global Survey of Esophageal Injury in Atrial Fibrillation Ablation: Characteristics and Outcomes of Esophageal Perforation and Fistula. JACCCEP. 2016;2(2):143-150.