For patients presenting in emergency situations with chest pain after recent radiofrequency ablation for atrial fibrillation treatment, one should consider CT angiography of the chest as it can aide in diagnosis of complications from the procedure; such as, pericardioesophageal fistula formation or the even more serious and lethal condition of a left atrial esophageal fistulous communication.

From the manuscript

Pericardioesophageal Fistula Following Left Atrial Ablation Procedure

Abstract
We present a case of pericardioesophageal fistula formation in a 40 year old male who 23 days after undergoing a repeat ablation procedure for atrial fibrillation developed chest pressure, chills and diaphoresis. After initial labs and tests that demonstrated no evidence for acute myocardial ischemia, the patient underwent CT angiography of the chest. The study revealed pneumopericardium and a pericardial effusion. Suspicion was raised of perforation of the posterior left atrial myocardial wall with injury to adjacent esophagus. Water soluble contrast with transition to barium sulfate esophagram subsequently performed identified a perforation further affirming the postulate of a fistulous communication between the esophagus and pericardium. Transthoracic echocardiogram confirmed pericardial effusion but did not demonstrate myocardial defect. Endoscopic management was preferred and an esophageal stent was placed. Follow up esophagram showed an intact esophageal stent without evidence of extravasation.