Atrioesophageal Fistula After Catheter Ablation of Atrial Fibrillation: Can We Really Prevent It?

Catheter ablation of atrial fibrillation (AF) is a widely used and established procedure in clinical practice. Several randomized studies have demonstrated the superiority of this method in patients with paroxysmal/persistent AF who are symptomatic and refractory to antiarrhythmic therapy, with a strong positive impact on quality of life and in reducing the clinical recurrence of this arrhythmia, regardless of the type of energy used.^– The primary objective of the procedure is the electrical isolation of the pulmonary veins, associated or not with more extensive lesions, particularly of the posterior wall.

The main complications related to the procedure, such as death, per-procedure thromboembolic event, atrioesophageal fistula (AEF), cardiac tamponade, severe pulmonary vein stenosis, and permanent phrenic nerve palsy are, in reality, infrequent complications (0.02 to 1.3%). A recent publication demonstrated a decrease in these complications in recent years (2018-2022) when compared to the previous five years (3.8 versus 5.3%).

[…]