title: Esophageal hematoma after atrial fibrillation ablation: incidence, clinical features, and sequelae of esophageal injury of a different sort.
abstract: BACKGROUND
  Esophageal hematoma recently has been reported as a form of esophageal injury after atrial fibrillation (AF) ablation, attributed to the use of transesophageal echocardiography (TEE). We sought to determine the incidence, clinical features, and sequelae of this form of esophageal injury.
  
  
  RESULTS
  This was a prospective series of 1110 AF ablation procedures performed under general anesthesia (GA) over 9 years. TEE was inserted after induction of GA to exclude left atrial appendage thrombus, define cardiac function, and guide transseptal puncture. The procedural incidence of esophageal hematoma was 0.27% (3/1110 procedures, mortality 0%). Odonyphagia, regurgitation, and hoarseness were the predominant symptoms, with an onset within 12 hours. There was absence of fever and neurological symptoms. Chest computed tomography excluded atrio-esophageal fistula and was diagnostic of esophageal hematoma localized to either the upper esophagus or extending the length of the mid and lower esophagus; endoscopy confirmed the diagnosis. Management was conservative in all cases comprising of ceasing oral intake and anticoagulation. Long term sequelae included esophageal stricture formation requiring dilatation, persistent esophageal dysmotility (mid esophageal hematoma), and vocal cord paralysis, resulting in hoarse voice (upper esophageal hematoma).
  
  
  CONCLUSIONS
  Esophageal hematoma is a rare but important differential diagnosis for esophageal injury after TEE-guided AF ablation under GA, and can result in significant patient morbidity. Key clinical features differentiate presentation of esophageal hematoma from that of an atrio-esophageal fistula.
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kumar
authors.forename: Liang-Han
authors.initials: LH
authors.lastname: Ling
authors.forename: Karen
authors.initials: K
authors.lastname: Halloran
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Morton
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Spence
authors.forename: Stephen
authors.initials: S
authors.lastname: Joseph
authors.forename: Peter M
authors.initials: PM
authors.lastname: Kistler
authors.forename: Paul B
authors.initials: PB
authors.lastname: Sparks
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D001466:Barium Sulfate; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D003287:Contrast Media; D003680:Deglutition Disorders / Q000453:epidemiology; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal / Q000009:adverse effects*; D004935:Esophageal Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D004937:Esophageal Fistula / Q000175:diagnosis; D004940:Esophageal Stenosis / Q000453:epidemiology; D004947:Esophagus / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005773:Gastroscopy; D006406:Hematoma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D006685:Hoarseness / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology; D014826:Vocal Cord Paralysis / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D003287:Contrast Media; D001466:Barium Sulfate