Atrioesophageal Fistula Following Atrial Fibrillation Ablation: A Case Report

Atrioesophageal fistula (AEF) is a rare but catastrophic complication of atrial fibrillation (AF) ablation, with mortality exceeding 90% in the absence of surgical intervention. We report the case of a 68-year-old man who developed AEF four weeks after radiofrequency ablation for AF. The patient initially presented with pneumopericardium and retrosternal chest pain, progressing to mediastinitis. Surgical repair with esophageal suture and muscle flap interposition was performed. Despite initial improvement, the patient developed neurological complications following early resumption of oral feeding. A second operation revealed left superior pulmonary vein perforation and dehiscence of esophageal sutures, requiring esophagectomy with cervical esophagostomy. Cultures grew <i>Streptococcus mitis</i>, <i>Neisseria macacae</i>, and <i>Staphylococcus epidermidis</i>. After six weeks of intravenous antibiotics and full neurological recovery, the patient was discharged. This case highlights the diagnostic challenges of AEF, the critical role of contrast-enhanced chest CT, and the need for delayed oral feeding after surgical repair.