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Introduction: Much have been reported about esophago‐left atrium fistula. However, esophago‐mediastinal fistula, not reaching the left atrium, has not been studied as a different clinical entity, with different management. Methods and Results: We review and discuss the literature of esophago‐mediastinum fistula after catheter ablation for atrial fibrillation with emphasis on the following points: the timing of its occurrence after ablation; the mechanisms and localization of the fistula; and its natural history. Conclusion: We showed that esophageal stenting was associated with a better outcome in patients with esophagus‐mediastinal fistula, introduced the concept of left atrial wall weakening during ablation, and suggest a possible role of contact force use in fistula formation. [ABSTRACT FROM AUTHOR]

The article describes the case of a 57-year-old man who developed ventricular tachycardia (VT) inducing typical atrioventricular-nodal reentrant tachycardia (AVNRT) with severe hypotension and persisting after termination of the VT. The patient was presented with an old anterior wall myocardial infarction and left ventricular ejection fraction of 0.3 and developed episodes of paroxysmal palpitations. Holter monitoring showed four salvos of short-lived broad QRS tachycardia.

The recognition of the presence, location, and properties of unusual accessory pathways for atrioventricular conduction is an exciting, but frequently a difficult, challenge for the clinical cardiac arrhythmologist. In this third part of our series of reviews, we discuss the different steps required to come to the correct diagnosis and management decision in patients with nodofascicular, nodoventricular, and fasciculo‐ventricular pathways. We also discuss the concealed accessory atrioventricular pathways with the properties of decremental retrograde conduction that are associated with the so‐called permanent form of junctional reciprocating tachycardia. Careful analysis of the 12‐lead electrocardiogram during sinus rhythm and tachycardias should always precede the investigation in the catheterization room. When using programmed electrical stimulation of the heart from different intracardiac locations, combined with activation mapping, it should be possible to localize both the proximal and distal ends of the accessory connections. This, in turn, should then permit the determination of their electrophysiologic properties, providing the answer to the question "are they incorporated in a tachycardia circuit?". It is this information that is essential for decision‐making with regard to the need for catheter ablation, and if necessary, its appropriate site. [ABSTRACT FROM AUTHOR]

Recognition of the presence, location, and properties of unusual accessory pathways for atrioventricular conduction is an exciting, frequently difficult, challenge for the clinical cardiac arrhythmologist. In this second part of our series of reviews relative to this topic, we discuss the steps required to achieve the correct diagnosis and appropriate management in patients with the so‐called "Mahaim" variants of pre‐excitation. We indicate that, nowadays, it is recognized that these abnormal rhythms are manifest because of the presence of atriofascicular pathways. These anatomical substrates, however, need to be distinguished from the other long and short accessory pathways which produce decremental atrioventricular conduction. The atriofascicular pathways, along with the long decrementally conducting pathways, have their atrial components located within the vestibule of the tricuspid valve. The short decremental pathways, in contrast, can originate in the vestibules of either the mitral or tricuspid valves. As a starting point, careful analysis of the 12‐lead electrocardiogram, taken during both sinus rhythm and tachycardias, should precede any investigation in the catheterization room. When assessing the patient in the electrophysiological laboratory, the use of programmed electrical stimulation from different intracardiac locations, combined with entrainment technique and activation mapping, should permit the establishment of the properties of the accessory pathways, and localization of its proximal and distal ends. This should provide the answer to the question "is the pathway incorporated into the circuit underlying the clinical tachycardia". That information is essential for decision‐making with regard to need, and localization of the proper site, for catheter ablation. [ABSTRACT FROM AUTHOR]