title: Severity of esophageal injury predicts time to healing after radiofrequency catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  The delivery of radiofrequency (RF) energy to the posterior left atrium creates a risk of injury to the adjacent esophagus. Esophageal endoscopy (EGD) is used to screen patients at risk for esophageal thermal injury after RF ablation.
  
  
  OBJECTIVE
  The purpose of this study was to analyze the macroscopic features of the severity of esophageal injuries induced by RF ablation to the left atrium as seen by EGD and evaluate the association of these descriptions with the time elapsed until complete healing.
  
  
  METHODS
  This study analyzed 219 patients undergoing RF ablation for atrial fibrillation. Esophageal temperature probes were used during each ablation, and EGD was performed in cases with intraesophageal temperature ≥39°C. Repeat EGD was obtained at 10 days to evaluate for healing in all cases demonstrating esophageal injury. Serial endoscopies were repeated every 2 weeks until complete healing was documented. Lesions were classified according to severity as superficial or deep ulceration; size and shape were also noted.
  
  
  RESULTS
  We found 37.4% of patients (82 of 219) with esophageal intraluminal temperatures ≥39°C. Of these, 22 patients (27%) were identified with esophageal injury, with 68% being superficial ulcerations and 32% deep. On repeat EGD at 10 days, only 29% of deep ulcerations were healed, as compared with 87% of the superficial injuries (P = .0136). No difference in healing was found when analyzed for size or shape.
  
  
  CONCLUSIONS
  The macroscopic severity of esophageal lesions detected on endoscopy the day after RF ablation can predict the time to resolution, with severe, deep ulcerations requiring a longer time to heal.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Fernando M
authors.initials: FM
authors.lastname: Contreras-Valdes
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Danik
authors.forename: Conor D
authors.initials: CD
authors.lastname: Barrett
authors.forename: Dan
authors.initials: D
authors.lastname: Blendea
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
authors.forename: Leon
authors.initials: L
authors.lastname: Ptaszek
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Moussa
authors.initials: M
authors.lastname: Mansour
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D002056:Burns / Q000209:etiology* / Q000473:pathology; D017115:Catheter Ablation / Q000009:adverse effects*; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D013997:Time Factors; D014945:Wound Healing