Atrioesophageal fistula after atrial fibrillation ablation: a single-center experience with multicenter comparisons

Atrioesophageal fistula (AEF) is a rare yet highly lethal complication after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). Efficient screening and prompt surgical intervention within a multidisciplinary framework are critical for improving survival.

We retrospectively analyzed 12 patients who developed AEF after RFCA and underwent surgical repair at Beijing Anzhen Hospital from 2020 to 2024. A rapid screening protocol was implemented, including symptom-triggered CT/CTA with 48-h repeat imaging if needed and immediate surgical treatment under multidisciplinary team (MDT) consultation. Surgical management included median sternotomy under cardiopulmonary bypass (CPB) plus left thoracotomy, with atrial and esophageal repair and omental interposition.

The mean age was 63.5 ± 6.4 years, with 9 males and 3 females. Symptom onset occurred at a mean of 12.4 ± 8.1 days after ablation, most commonly fever (91.7%) and chest pain (83.3%). Diagnosis was achieved within 2 (range 1-10) days. All patients underwent emergency surgery; 11 received one-stage repair, while one required esophageal diversion due to severe mediastinitis. The in-hospital survival rate was 91.7% (11/12), with no recurrence observed during a median follow-up 12 (range 3-18) months. Postoperative complications occurred in two patients (16.7%), both developing pneumonia which resolved with antibiotic therapy.

A structured rapid screening pathway combined with prompt MDT-based surgical treatment significantly improved survival in patients with AEF. Our protocol achieved a high survival rate and may offer a valuable reference for other centers.