A 50-year-old woman with chronic kidney disease and rheumatoid arthritis underwent radiofrequency catheter ablation for symptomatic persistent atrial fibrillation. The pa-, tient sought treatment at the emergency room after 4 weeks with minor hematemesis. Esophagogastroduodenoscopy revealed a thrombus along the esophageal wall (A). Computed tomography scans of the chest demonstrated abnormal contouring of the left atrial wall, concerning for atrioesophageal fistula and pleural effusions (B and C, red arrow). Emergency cardiac and esophageal surgery was performed, during which the left atrium was repaired via a pericardial patch. The esophageal ulcer was resected and the esophagus was anastomosed in end-to-end fashion.
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