Persistent atrial fibrillation associated with gastroesophageal reflux accompanied by hiatal hernia.

lower-arm radiocephalic fistulas were created, the fistula patency was 74.1%, 64.2%, 49.8%, 33.7%, and 4.1% after 1, 2, 3, 4, and 5 years, respectively (7). In this presented case with diabetes the patency is much lower, so the risk for CVS is higher. In most of the papers reporting on CVS after fistula creation on the ipsilateral arm of the pacemaker, the authors suggest that phlebography should systematically be performed before the fistula is created, in order to diagnose pre-existing CVS (8). On the other hand the risk of bleeding complications is much higher in ICD implantation in a vein perfused by an AV fistula because of increased blood flow and reduced vessel compliance. With these considerations in mind we decided to implant the device on the side of the fistula protecting the other side for future AV fistula access.