Periesophageal vagal nerve injury following catheter ablation of atrial fibrillation: A case report and review of the literature

Introduction Percutaneous catheter ablation is an established rhythm control strategy for the treatment of atrial fibrillation (AF). Recent clinical trials show that catheter ablation of atrial fibrillation reduces the risk of recurrence of symptomatic AF, atrial flutter, or atrial tachycardia, and may also reduce subsequent hospitalizations and improve quality of life compared to antiarrhythmic drug therapy. Catheter ablation has garnered a class I recommendation for patients with symptomatic paroxysmal AF who are refractory or intolerant to at least one class I or III antiarrhythmic medication, and has a class IIa recommendation as a reasonable initial rhythm control strategy in the 2014 guidelines published by the American College of Cardiology/ American Heart Association/Heart Rhythm Society. Catheter ablation for AF is widely regarded as a safe procedure. A recently published retrospective analysis of AF catheter ablation (performed in 83,236 patients enrolled in a total of 192 published clinical trials) reported an overall periprocedural complication rate of 2.9%. The majority of the complications were vascular in nature with an incidence of 1.4%. Gastrointestinal (GI) complications following catheter ablation for AF are exceedingly rare. The most serious GI complication after catheter ablation is formation of an atrioesophageal fistula, which has a very low incidence (0.03%-0.1% of cases). However, atrioesophageal fistulae can lead to potentially life-threatening sequelae including catastrophic bleeding, septicemia, cerebrovascular accidents, and air embolism, and carry a mortality rate exceeding 80%.