title: The transesophageal echo probe may contribute to esophageal injury after catheter ablation for paroxysmal atrial fibrillation under general anesthesia: a preliminary observation.
abstract: BACKGROUND
  The transesophageal echo probe (TEE) is commonly used before and during atrial fibrillation (AF) ablation under general anesthesia (GA). We sought to determine the potential contribution of the TEE probe to esophageal injury after pulmonary vein isolation (PVI) alone for paroxysmal AF.
  
  
  RESULTS
  Seventy-six patients undergoing PVI with TEE, PVI/TEE, 16 undergoing PVI without TEE (PVI/No TEE), and 27 undergoing TEE without any left atrial ablation (TEE/No LA ablation) under GA were included. Posterior wall ablation was power (20-25 W) and time limited (electrogram attenuation or ≤30 s). Esophageal capsule endoscopy (n = 206) was performed pre- and post-procedure and at 2 weeks. Esophageal lesions were seen in 30% of PVI/TEE, 0% of patients in the PVI/No TEE (P = 0.009), and 22% of TEE/No LA ablation groups (P = 0.47 vs. PVI/TEE). There were no instances of esophageal bleeding, perforation, or need for gastrointestinal intervention. Self-resolving dysphagia was the only reported symptom (5%). All lesions healed within 2 weeks. There was no significant difference in the location or morphological appearance of esophageal lesions seen in the PVI/TEE versus TEE/No LA ablation groups.
  
  
  CONCLUSIONS
  Esophageal lesions were seen in 30% of patients undergoing PVI alone under GA with use of TEE and in a similar proportion (22%) of patients undergoing TEE in the absence of left atrial ablation. This study makes the preliminary observation that one must be cognizant of the TEE probe as a potential contributor to esophageal injury after AF ablation. Larger studies are needed to confirm these findings.
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Kumar
authors.forename: Gregor
authors.initials: G
authors.lastname: Brown
authors.forename: Fiona
authors.initials: F
authors.lastname: Sutherland
authors.forename: John
authors.initials: J
authors.lastname: Morgan
authors.forename: David
authors.initials: D
authors.lastname: Andrews
authors.forename: Liang-Han
authors.initials: LH
authors.lastname: Ling
authors.forename: Alex J A
authors.initials: AJ
authors.lastname: McLELLAN
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Lee
authors.forename: Timothy
authors.initials: T
authors.lastname: Robinson
authors.forename: Patrick
authors.initials: P
authors.lastname: Heck
authors.forename: Karen
authors.initials: K
authors.lastname: Halloran
authors.forename: Joseph
authors.initials: J
authors.lastname: Morton
authors.forename: Peter
authors.initials: P
authors.lastname: Kistler
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Kalman
authors.forename: Paul B
authors.initials: PB
authors.lastname: Sparks
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D053704:Capsule Endoscopy; D017115:Catheter Ablation / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000209:etiology; D017548:Echocardiography, Transesophageal / Q000009:adverse effects* / Q000295:instrumentation; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects* / Q000295:instrumentation; D014945:Wound Healing; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology*
keywords: atrial fibrillation; catheter ablation; esophageal hematoma; esophageal injury; esophageal lesions; esophageal ulceration; transesophageal echocardiography