A Woman with a Racing Heart, Fatigue, and Dyspnea

Over the next month, she developed progressive dyspnea, weight gain, edema, and dysphagia. Imaging showed pleural and pericardial effusions, as well as pneumopericardium. ECG variably displayed PR-interval depressions, ST-segment elevations, and low QRS voltages. The differential diagnosis centered on postablation complications, particularly involving the cardiac-esophageal interface (Figure 1). Ultimately, the patient was diagnosed with an esophageal–pericardial fistula and underwent surgical repair.