Pericardial–esophageal fistula caused by radiofrequency ablation for atrial fibrillation

Abstract

A 48-year-old male visited our emergency department for sudden onset of chest pain for 5 h. He had undergone radiofrequency ablation for atrial fibrillation 20 days ago. Laboratory tests revealed a white blood cell count of 12.2 × 10⁹/L, a neutrophil percentage of 91%, an ultrasensitive C-reactive protein of 20.73 mg/L, and an erythrocyte sedimentation rate of 54 mm/1 h end. Transthoracic echocardiography revealed left heart enlargement, moderate mitral regurgitation, and mildly decreased left ventricular systolic function. Computed tomography (CT) showed clustered air bubbles adjacent to the mid-oesophagus (Panel A), a large amount of pneumopericardium, and a small amount of intrapericardial fluid (Panels B and C). Given his history, we suspected a pericardial–esophageal fistula (PEF). Emergency PEF was explored, intraoperatively, and it was observed that there was an 8 mm fistula in the mid-oesophagus and pyopericardium. The patient underwent surgical repair of the PEF with the wrapping of the omentum and pericardiotomy for abscess evacuation. Cardiac computed tomography angiography reexamination showed that the fistula had completely healed after 3 days (Panel D). The patient had an uneventful recovery and was discharged without further incident.