Cryoballoon ablation for atrial fibrillation in a patient with esophageal dilatation due to achalasia

Key Teaching Points•Collateral damage of the esophagus is one of the significant risks in catheter ablation for atrial fibrillation, as it can lead to atrial-esophageal and pericardial-esophageal fistulas.•Esophageal achalasia is a neurodegenerative disorder characterized by failure of lower esophageal sphincter relaxation and loss of peristalsis to the distal esophagus, which may increase the risk of esophageal injury by causing marked dilatation of the esophagus.•Cryoballoon ablation may be a safe ablation approach for patients with a dilated esophagus due to esophageal achalasia. •Collateral damage of the esophagus is one of the significant risks in catheter ablation for atrial fibrillation, as it can lead to atrial-esophageal and pericardial-esophageal fistulas.•Esophageal achalasia is a neurodegenerative disorder characterized by failure of lower esophageal sphincter relaxation and loss of peristalsis to the distal esophagus, which may increase the risk of esophageal injury by causing marked dilatation of the esophagus.•Cryoballoon ablation may be a safe ablation approach for patients with a dilated esophagus due to esophageal achalasia.