title: Esophageal perforation during left atrial radiofrequency ablation: Is the risk too high?
abstract: OBJECTIVE
  Intraoperative radiofrequency ablation of atrial fibrillation (IRAAF) is a recently developed procedure being performed in an increasing number of patients. We have performed left atrial IRAAF in 387 patients since August 1998. The purpose of this article is to describe a serious complication of this procedure, namely IRAAF-induced esophageal perforation, in detail to identify possible risk factors.
  
  
  METHODS
  Left atrial IRAAF was performed with a commercially available unipolar probe as an isolated procedure (n = 129) or in combination with mitral valve surgery (n = 163) or other surgical procedures (n = 95). Operations were performed either through a conventional sternotomy or right minithoracotomy.
  
  
  RESULTS
  Four (1%) patients had esophageal perforation after radiofrequency ablation. All 4 patients presented after an initially unremarkable postoperative course, with sudden neurologic symptoms from esophagoatrial air embolization occurring in 3 of the patients. Three patients were successfully treated with extensive esophageal resection, and one died from massive air embolism. All perforations occurred in patients undergoing minimally invasive IRAAF. Comparison with other patients undergoing isolated minimally invasive IRAAF (n = 129) failed to reveal any reliable predictors of esophageal injury, including patient body size, operating times, or radiofrequency biophysical parameters.
  
  
  CONCLUSIONS
  Left atrial IRAAF is associated with a small but definite risk of esophageal perforation. Unfortunately, we were unable to identify any risk factors for this life-threatening complication. A high degree of vigilance must be maintained for esophageal injury after IRAAF, particularly in patients with new neurologic deficits. Until safer methods of ablation are developed, we currently recommend against the use of IRAAF in patients undergoing cardiac surgery.
authors.affiliation: Clinic for Heart Surgery, Heart Center, University of Leipzig, Leipzig, Germany. dolln@medizin.uni-leipzig.de
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doll
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Alexander
authors.initials: A
authors.lastname: Fabricius
authors.forename: Susann
authors.initials: S
authors.lastname: Stephan
authors.forename: Jan
authors.initials: J
authors.lastname: Gummert
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Johann
authors.initials: J
authors.lastname: Hauss
authors.forename: Hans
authors.initials: H
authors.lastname: Kottkamp
authors.forename: Gerd
authors.initials: G
authors.lastname: Hindricks
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors