Left atrial-esophageal fistula is a highly lethal complication of ablative therapy for atrial fibrillation. Because of its unusual rate of occurrence, there has not been a uniform approach to either the diagnosis or corrective therapy. We offer 1 such surgical option based on presumptive and early diagnosis-left atrial repair with cardiopulmonary bypass followed by repair of the esophagus with an omental wrap and supported with decompressive gastrostomy and feeding jejunostomy.