Esophageal fistula formation despite esophageal monitoring and low-power radiofrequency catheter ablation for atrial fibrillation.

Esophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation.1 The mechanism of esophageal injury is not known. Potential mechanisms for injury include direct thermal injury and ischemic injury from damage to the esophageal blood supply. Current ablation strategies use various methods to avoid esophageal injury. We describe an unusual manifestation of esophageal injury despite multiple preventive measures.