The reported rate of atrioesophageal fistula with Arctic Front Advance cryoballoon is

• A. <1 in 25000
• B. 1 in 1000
• C. 1 in 100
• D. 1 in 2

Answer: (A)

Atrioesophageal fistula is a devastating but extremely rare complication of left atrial ablation, because the esophagus lies directly behind the left atrium and can be injured when energy is delivered near the posterior wall. With Arctic Front Advance cryoballoon, the reported incidence is very low. Large experience and registries show this complication occurs only a few times in tens of thousands of procedures, with the best-supported figure being less than 1 in 25,000. This reflects the localized nature of cryothermal lesions and the safety measures used, such as monitoring esophageal temperature and carefully limiting energy near the posterior atrial wall. Rates as high as 1 in 1000, 1 in 100, or even 1 in 2 are not consistent with current data.