Incidence, Clinical Features, and Sequelae of Esophageal Injury of a Different Sort

Radiofrequency (RF) ablation of atrial fibrillation (AF) is associated with a risk of collateral esophageal injury, of which an atrio-esophageal fistula is the most devastating complication. Transesophageal echo (TEE) is used commonly at the time of AF ablation procedures to exclude left atrial thrombus, define cardiac function, and in some centers to guide transseptal puncture. Recently, Nguyen et al reported a case of an esophageal hematoma as a complication after an AF ablation. This was attributed to the use of TEE during the procedure. While the presentation and risk factors for RF-related esophageal injury are well described, only isolated cases of esophageal hematoma have been reported. As such, our understanding of this condition remains limited and the differentiating clinical features from an atrioesophageal fistula remained undefined. The aim of this study was to describe the incidence, characteristics, and sequelae of esophageal hematoma in a large center, where TEE is used routinely in the setting of AF ablation under general anesthesia (GA). Editorial see p 621 Clinical Perspective on p 705