Journal of Clinical PracticeJournal of Clinical PracticeКлиническая практика2220-30952618-8627Eco-Vector69554510.17816/clinpract695545UKANWICase reportsКлинические случаиResearch ArticleAtrioesophageal fistula after radiofrequency catheter ablation for atrial fibrillation: clinical caseПредсердно-пищеводный свищ как редкое и опасное осложнение радиочастотной абляции при фибрилляции предсердий: клинический случай и обзорhttps://orcid.org/0000-0003-3161-90363136-6737GaskinVladislav V.ГаскинВладислав Владимирович
Russian Federation

MD

drgaskinv@gmail.comhttps://orcid.org/0000-0001-6973-42386323-5496GaskinaAnna A.ГаскинаАнна Арутюновна
Russian Federation

MD, PhD

канд. мед. наук

drgaskina@gmail.comhttps://orcid.org/0000-0001-6294-12855357-1487MasriAmir G.МасриАмир Гази
Russian Federation

MD

amir.masri@yandex.ruhttps://orcid.org/0000-0002-6716-55932527-0130NеchaevValentin A.НечаевВалентин Александрович
Russian Federation

MD, PhD

канд. мед. наук

dfkz2005@gmail.comhttps://orcid.org/0000-0002-0392-82808919-9645MarkarovArnold E.МаркаровАрнольд Эдуардович
Russian Federation

MD, PhD

канд. мед. наук

markarnold@mail.ruCity Clinical Hospital named after F.I. InozemtsevГородская клиническая больница имени Ф.И. ИноземцеваCity Clinical Hospital named after A.K. EramishantsevГородская клиническая больница имени А.К. ЕрамишанцеваCity Clinical Hospital named after S.S. YudinГородская клиническая больница имени С.С. Юдина08012026010520261711311403010202507122025Copyright ©; 2026, Eco-VectorCopyright ©; 2026, Эко-Вектор2026Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://clinpractice.ru/clinpractice/article/view/695545

BACKGROUND: Atrioesophageal fistula is a rare complication following radiofrequency catheter ablation for atrial fibrillation and is associated with high mortality. Clinical manifestations of atrioesophageal fistula are nonspecific and may include fever, neurological symptoms, and sepsis, which complicates timely diagnosis. A literature search was conducted in international databases PubMed, Google Scholar and eLibrary for the last five years (2019–2024) using the keywords “atrioesophageal fistula” and “complications of radiofrequency catheter ablation.” Thirty articles were selected for review. CLINICAL CASE DESCRIPTION: The aim of this publication is to present a rare case of atrioesophageal fistula development after radiofrequency catheter ablation in a 53-year-old female patient. The features of the clinical course, diagnostic challenges, as well as possible approaches to early recognition, prevention, and treatment of this complication were analyzed. CONCLUSION: Even when diagnosed early, atrioesophageal fistula carries an exceedingly poor prognosis. This underscores the critical need for sustained clinical vigilance, improved prevention strategies, and the establishment of standardized management guidelines for suspected cases of this lethal complication.

Обоснование. Предсердно-пищеводный свищ — жизнеугрожающее редкое осложнение после радиочастотной катетерной абляции по поводу фибрилляции предсердий, характеризуемое крайне высокой летальностью. Клиническая картина предсердно-пищеводного свища неспецифична и часто включает лихорадку, неврологический дефицит и симптомы сепсиса, что обусловливает трудности своевременной диагностики. На основе собственного наблюдения и данных литературы проведён комплексный анализ патогенеза, особенностей клинического течения, диагностики с акцентом на визуализацию, а также современных стратегий лечения и профилактики этого грозного осложнения. Описание клинического случая. Представлено описание клинического случая предсердно-пищеводного свища у пациентки в возрасте 53 лет, развившегося после радиочастотной катетерной абляции, при этом особое внимание уделяется роли методов лучевой диагностики. Проиллюстрированы ключевые изменения, выявленные с помощью компьютерной и магнитно-резонансной томографии, такие как визуализация свищевого хода и церебральная воздушная эмболия, что сыграло решающую роль в верификации диагноза. Заключение. Даже при раннем распознавании предсердно-пищеводного свища у пациента сохраняется неблагоприятный прогноз, что требует постоянной настороженности врачей, совершенствования профилактических мер и разработки стандартов ведения пациентов с подозрением на это жизнеугрожающее осложнение.

atrial fibrillationradiofrequency ablationcatheter ablationatrioesophageal fistulaablation complicationscase report.фибрилляция предсердийрадиочастотная абляциякатетерная абляцияпредсердно-пищеводный свищосложнения абляцииклинический случайVan Gelder IC, Rienstra M, Bunting KV, et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314–3414. doi: 10.1093/eurheartj/ehae176 EDN: TPYMALChugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 Study. Circulation. 2014;129(8):837–847. doi: 10.1161/CIRCULATIONAHA.113.005119 EDN: SPJCTVAndrade JG, Wells GA, Deyell MW, et al. Cryoablation or drug therapy for initial treatment of atrial fibrillation. N Engl J Med. 2021;384(4):305–315. doi: 10.1056/NEJMoa2029980 EDN: YFHSGDMarrouche NF, Brachmann J, Andresen D, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417–427. doi: 10.1056/NEJMoa1707855 EDN: XXDBJJPacker DL, Mark DB, Robb RA, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321(13):1261–1274. doi: 10.1001/jama.2019.0693 EDN: MQXJXBCappato R, Calkins H, Chen SA, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3(1):32–38. doi: 10.1161/CIRCEP.109.859116Nikolaos D, Hindricks G, Kottkamp H, et al. Complications of atrial fibrillation ablation in a high‐volume center in 1,000 procedures: still cause for concern? J Cardiovasc Electrophysiol. 2009;20(9):1014–1019. doi: 10.1111/j.1540-8167.2009.01493.xHan HC, Ha FJ, Sanders P, et al. Atrioesophageal fistula: clinical presentation, procedural characteristics, diagnostic investigations, and treatment outcomes. Circ Arrhythm Electrophysiol. 2017;10(11):e005579. doi: 10.1161/CIRCEP.117.005579Martinek M, Bencsik G, Aichinger J, et al. Esophageal damage during radiofrequency ablation of atrial fibrillation: impact of energy settings, lesion sets, and esophageal visualization. J Cardiovasc Electrophysiol. 2009;20(7):726–733. doi: 10.1111/j.1540-8167.2008.01426.xDi Biase L, Saenz LC, Burkhardt JD, et al. Esophageal capsule endoscopy after radiofrequency catheter ablation for atrial fibrillation: documented higher risk of luminal esophageal damage with general anesthesia as compared with conscious sedation. Circ Arrhythm Electrophysiol. 2009;2(2):108–112. doi: 10.1161/CIRCEP.108.815266Singh SM, D’Avila A, Singh SK, et al. Clinical outcomes after repair of left atrial: esophageal fistulas occurring after atrial fibrillation ablation procedures. Heart Rhythm. 2013;10(11):1591–1597. doi: 10.1016/j.hrthm.2013.08.012Cummings JE, Schweikert RA, Saliba WI, et al. Brief communication: atrial-esophageal fistulas after radiofrequency ablation. Ann Intern Med. 2006;144(8):572–574. doi: 10.7326/0003-4819-144-8-200604180-00007Pappone C, Oral H, Santinelli V, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation. 2004;109(22):2724–2726. doi: 10.1161/01.CIR.0000131866.44650.46Colwell C, Strat N, Keramati C, et al. Atrioesophageal fistula: imaging for a definitive diagnosis. Am J Diagn Imaging. 2023;9(2):28–37. doi: 10.5455/ajdi.20230125070139Malamis AP, Kirshenbaum KJ, Nadimpalli S. CT radiographic findings: atrio-esophageal fistula after transcatheter percutaneous ablation of atrial fibrillation. J Thorac Imaging. 2007;22(2):188–191. doi: 10.1097/01.rti.0000213569.63538.30Abdelradi A, Moore J, Sayed A, et al. Atrioesophageal fistula after atrial fibrillation ablation: a case report. CJC Open. 2022;4(12):1093–1095. doi: 10.1016/j.cjco.2022.08.009 EDN: RBMGBDLiu A, Lin M, Maduray K, et al. Clinical manifestations, outcomes, and mortality risk factors of atrial-esophageal fistula: a systematic review. Cardiology. 2022;147(1):26–34. doi: 10.1159/000519224 EDN: LYIIICNair KK, Shurrab M, Skanes A, et al. The prevalence and risk factors for atrioesophageal fistula after percutaneous radiofrequency catheter ablation for atrial fibrillation: the Canadian experience. J Interv Card Electrophysiol. 2014;39(2):139–144. doi: 10.1007/s10840-013-9853-z EDN: CFVBZIHa FJ, Han HC, Sanders P, et al. Challenges and limitations in the diagnosis of atrioesophageal fistula. J Cardiovasc Electrophysiol. 2018;29(6):861–871. doi: 10.1111/jce.13494Della Rocca DG, Magnocavallo M, Natale VN, et al. Clinical presentation, diagnosis, and treatment of atrioesophageal fistula resulting from atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2021;32(9):2441–2450. doi: 10.1111/jce.15168 EDN: MDIPYAZhang P, Bian Y. Cerebral arterial air embolism secondary to iatrogenic left atrial-esophageal fistula: a case report. BMC Neurol. 2020;20(1):16. doi: 10.1186/s12883-020-1602-1 EDN: LBDZZRCunqueiro A, Scheinfeld MH. Causes of pneumocephalus and when to be concerned about it. Emerg Radiol. 2018;25(4):331–340. doi: 10.1007/s10140-018-1595-x EDN: PYFMUKMohanty S, Santangeli P, Mohanty P, et al. Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting. J Cardiovasc Electrophysiol. 2014;25(6):579–584. doi: 10.1111/jce.12386Quénéhervé L, Musquer N, Léauté F, et al. Endoscopic management of an esophagopericardial fistula after radiofrequency ablation for atrial fibrillation. World J Gastroenterol. 2013;19(21):3352–3353. doi: 10.3748/wjg.v19.i21.3352Eitel C, Rolf S, Zachäus M, et al. Successful nonsurgical treatment of esophagopericardial fistulas after atrial fibrillation catheter ablation: a case series. Circ Arrhythm Electrophysiol. 2013;6(4):675–681. doi: 10.1161/CIRCEP.113.000384Fürnkranz A, Bordignon S, Schmidt B, et al. Luminal esophageal temperature predicts esophageal lesions after second-generation cryoballoon pulmonary vein isolation. Heart Rhythm. 2013;10(6):789–793. doi: 10.1016/j.hrthm.2013.02.021Pappone C, Carlo H, Santinelli V, et al. Atrio-esophageal fistula as a complication of percutaneous transcatheter ablation of atrial fibrillation. Circulation. 2004;109(22):2724–2726. doi: 10.1161/01.CIR.0000131866.44650.46Guo L, Ou S, Zhang S, Li D, et al. Atrioesophageal fistula after atrial fibrillation ablation: a single-center experience with multicenter comparisons. BMC Surg. 2025 Dec 2. doi: 10.1186/s12893-025-03371-0Grinberg R, Ilgiyaev E, Rapoport A, et al. Atrio-esophageal fistula following left atrial ablation for the treatment of atrial fibrillation: a report of 2 cases. Am J Case Rep. 2023;24:e939769. doi: 10.12659/AJCR.93976Saleh K, Bigley J, Malone S, et al. Atrio-esophageal fistula secondary to atrial fibrillation ablation: a case report. J Emerg Med. 2020;59(5):e187–e191. doi: 10.1016/j.jemermed.2020.07.019 EDN: UTMONZWang X, Yin H, Cao M, et al. Atrial-esophageal fistula after atrial fibrillation ablation: a case report and literature review. Ann Transl Med. 2023;11(2):138. doi: 10.21037/atm-22-6570 EDN: FYCMWPVeseli G, Iwai S, Jacobson JT. Survival of a patient with an esophagopericardial fistula after catheter ablation for atrial fibrillation: a case report and literature review. J Innov Card Rhythm Manag. 2020;11(5):4091–4098. doi: 10.19102/icrm.2020.110503 EDN: XZUZUIBack Sternick E, Soares Correa F, Ferber Drumond L, et al. Esophago-pericardial fistula after catheter ablation of atrial fibrillation: a review. J Cardiovasc Electrophysiol. 2020;31(10):2600–2606. doi: 10.1111/jce.14723 EDN: AXPPUIDhaliwal KK, Pawa R, Lata AL. Combined management of esophagopericardial fistula sustained after catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2021;32(5):1449–1451. doi: 10.1111/jce.15005 EDN: IVPCBSHe F, Zhang WM, Xu BJ, et al. Atrioesophageal fistula after atrial fibrillation catheter ablation: a case report. Medicine. 2021;100(2):e24226. doi: 10.1097/MD.0000000000024226 EDN: JKMIFEВоробьева Д.О., Снежицкий В.А. Осложнения процедуры радиочастотной абляции устьев легочных вен при фибрилляции предсердий // Журнал Гродненского государственного медицинского университета. 2017. № 1. С. 13–19. [Vorobyeva DO, Snezhitskiy VA. Complications after radiofrequency ablation of pulmonary veins ostia in atrial fibrillation. Journal of the Grodno State Medical University. 2017;(1):13–19]. EDN: YJMHYNСерова М.В., Сазонова Ю.С., Сафонов Н.В., и др. Катетерная аблация фибрилляции предсердий в практике кардиолога и терапевта // Consilium Medicum. 2025. Т. 27, № 1. С. 6–11. [Serova MV, Sazonova YS, Safonov NV, et al. Catheter ablation of atrial fibrillation in the practice of a cardiologist and therapist: a review. Consilium Medicum. 2025;27(1):6–11]. doi: 10.26442/20751753.2025.1.203052 EDN: ETOKNQ