Successful pulsed field ablation of left atrial roof-dependent atrial tachycardia arising after pericardial esophageal fistula

Atrial fibrillation (AF) is commonly treated with catheter ablation, with pulmonary vein isolation (PVI) using radiofrequency catheter ablation (RFCA) or cryoballoon ablation being well-established techniques. Despite their effectiveness, thermal ablation poses a significant risk of collateral damage to adjacent structures, particularly the esophagus. Atrio-esophageal fistula (AEF) and pericardial esophageal fistula (PEF) are rare but often fatal complications resulting from thermal injury from ablation.