Atrio-Oesphageal Fistula Following Pulmonary Vein Ablation

A 72 year old male with permanent AF was referred for a pulmonary vein isolation procedure. He had associated ischaemic heart disease, with prior myocardial infarctions in 1980 and 1981 and coronary artery bypass grafting in 1988. PAF developed in 2000, with a possible TIA. LV function was impaired with an ejection fraction of 40%. He was started on amiodarone and warfarin and after a second cardioversion maintained sinus rhythm for 5 years. In 2004 he had a drug eluting stent to distal LAD and in July 2005, a brainstem stroke with minor residual sensory deficit. AF recurred in 2006 and repeat cardioversion x3 was unsuccessful at maintaining sinus rhythm.