In 2021, a 64-year-old patient with paroxysmal atrial fibrillation underwent radiofrequency catheter ablation at our center. Several days later, he initially developed pericarditis, followed by a septic state, which was subsequently identified as an epiphenomenon of an atrio-esophageal fistula. The patient underwent combined surgical and endoscopic repair, and despite a complicated postoperative course, he returned to leading a normal life. The atrio-esophageal fistula is one of the most feared complications of atrial fibrillation ablation, associated with high mortality and morbidity. Its severity is exacerbated by diagnostic challenges, which may delay intervention, as well as the high surgical risk associated with repair techniques, and the limited evidence on prevention during the ablation procedure.
