title: Esophageal and Mediastinal Lesions Following Multielectrode Duty-Cycled Radiofrequency Pulmonary Vein Isolation: Simple Equals Safe?
abstract: BACKGROUND
  The development of esophageal lesions following atrial fibrillation (AF) ablation has frequently been reported. Mediastinal tissue layers and the posterior wall of the left atrium are in close proximity to the site of ablation. Hence, mucosal lesions might solely represent the "tip of the iceberg." We therefore investigated patients undergoing multielectrode phased radiofrequency (RF) ablation (PVAC®, Medtronic Inc., Minneapolis, MN, USA) for symptomatic AF by radial endosonography (EUS) in conjunction with conventional endoscopy esophago-gastro-duodenoscopy (EGD) to visualize potential mediastinal injuries following pulmonary vein isolation (PVI).
  
  
  RESULTS
  Eighteen patients (six women, mean age 52.8 ± 12.8 years, range 32-72 years) underwent PVI using multielectrode phased RF ablation and EGD and EUS following PVI within 48 hours. Postablation periesophageal lesions were detected by EUS in 10 out of 18 patients (56%). Four out of 10 lesions consisted of mild changes like small pericardial effusions, whereas six out of 10 patients had more severe lesions of the mediastinum, including one patient with changes of the esophageal mucosa. No atrio-esophageal fistula developed during follow-up (FU; mean FU 215 ± 105 days).
  
  
  CONCLUSIONS
  Mediastinal and esophageal structural changes occurred in a substantial number of patients. These findings highlight the necessity of close FU and the awareness of the potential development of an atrio-esophageal fistula also after multielectrode catheter ablation.
authors.affiliation: Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital of Muenster, Münster, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zellerhoff
authors.affiliation: Department of Gastroenterology, University Hospital of Muenster, Münster, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Lenze
authors.affiliation: Department of Gastroenterology, University Hospital of Muenster, Münster, Germany.
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Ullerich
authors.affiliation: Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital of Muenster, Münster, Germany.|Division of Cardiovascular Diseases, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Alex
authors.initials: A
authors.lastname: Bittner
authors.affiliation: Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital of Muenster, Münster, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Wasmer
authors.affiliation: Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital of Muenster, Münster, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Köbe
authors.affiliation: Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital of Muenster, Münster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Pott
authors.affiliation: Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital of Muenster, Münster, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.affiliation: Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital of Muenster, Münster, Germany.
authors.forename: Gerold
authors.initials: G
authors.lastname: Mönnig
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D004947:Esophagus / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging / Q000293:injuries*; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: atrial fibrillation; endosonography; esophageal injury; fistula; mediastinal injury; multielectrode catheter ablation