Pulmonary vein isolation in a patient with achalasia and megaesophagus

Abstract

Atrioesophageal fistula (AEF) is a rare but life-threatening complication of catheter ablation of atrial fibrillation (AF), thought to occur in as many as 0.03%–0.08% of cases.1 It is not known if patients with existing esophageal disorders, particularly those that dilate the esophagus, are at higher risk of AEF after pulmonary vein isolation (PVI). Achalasia is an inflammatory and neurodegenerative disorder of the esophagus characterized by increased tone and failure of relaxation of the lower esophageal sphincter as well as absent peristalsis of the esophageal body, often leading to progressive esophageal dilation and megaesophagus. Here we present a case of a 73-year-old man with symptomatic paroxysmal AF and achalasia and marked esophageal dilation despite Heller myotomy who underwent PVI with Cryoballoon (Medtronic, Minneapolis, MN), pharmacologic esophageal protection, and a multisensor esophageal temperature (ET) monitor.