When the Esophagus Disrupts the Rhythm: New-Onset Atrial Fibrillation After Stent Placement

Atrial fibrillation (AF) is a recognized complication following esophagectomy and radiotherapy for esophageal cancer but is rarely reported after esophageal stent placement. The mechanisms are thought to include direct mechanical irritation, vagal stimulation, and local inflammation affecting the posterior left atrium. However, the incidence of AF following esophageal stenting remains undocumented. We report the case of an 88-year-old woman with an ulcerated esophageal mass causing dysphagia and weight loss, who developed new-onset AF with rapid ventricular response following esophageal stent placement. The patient had no prior history of arrhythmia and no reversible metabolic or structural cardiac triggers. Telemetry confirmed AF shortly after the procedure. Rate control was achieved with amiodarone. Given recent gastrointestinal bleeding, anticoagulation was deferred at discharge. Her course was further complicated by a lack of follow-up and readmission four months later with progressive decline. This case highlights a rare but important complication of esophageal stenting. The close anatomical proximity of the esophagus to the left atrium may predispose to arrhythmias via mechanical compression and autonomic or inflammatory pathways. While individual case reports have proposed this link, no studies or registries have quantified its incidence. Our case is unique due to the patient's advanced age, ulcerated mass, and rapid clinical deterioration post-stent. New-onset AF following esophageal stent placement may be underrecognized. Awareness of this potential complication is essential, particularly in patients with limited options for anticoagulation. Future studies should investigate the incidence of AF post-stenting and assess whether targeted monitoring or prophylactic measures are warranted in high-risk populations.