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- W2978017104 abstract "Introduction: Left atrial radiofrequency ablation (LA-RFA) is a successful and relatively safe treatment for atrial fibrillation (AF). Major complications have been reported at a rate of 2-6%, but associated esophageal injury has been rarely reported. Clinical and endoscopic presentation is variable, and prompt management is critical to avoid poor outcomes. We present a unique case of severe esophageal dysphagia caused by LA-RFA. Case Report: A 67-year-old man presented with acute onset of dysphagia to solids 5 days following coronary artery bypass surgery (CABG) and LA-RFA for AF. He had associated chest discomfort, weight loss of 45 pounds in 5 months and impaired quality of life. He had no previous history of dysphagia or other gastrointestinal conditions. Initial barium swallow and upper endoscopy (EGD) showed inflammation and narrowing of the distal esophageal lumen. Pathology was non-diagnostic. Elsewhere, the patient had received empiric therapy with proton pump inhibitor and fluconazole for 3 weeks to treat candida esophagitis without improvement. Re-evaluation with EGD at our hospital showed severe esophageal stenosis measuring 14cm in length (6mm inner diameter), severe mucosal inflammation and white exudate. Pathology showed necroinflammatory material with granulation tissue. Fungal stain and viral testing were negative. Endoscopic dilation or stenting of this stricture were not attempted due to disease extent and risk of complications. Subsequently, he underwent chest imaging and thoracic surgery consultation followed by successful minimally invasive esophagectomy for ischemic necrosis of the esophagus. Discussion: While LA-RFA is generally safe, esophageal complications have extremely high morbidity and mortality depending on the depth of tissue injury. This unique case of a 14cm esophageal stricture was due to thermal injury from LA-RFA, leading to debilitating dysphagia and malnutrition. The esophagus is vulnerable to thermal injury due to its anatomical location. Understanding the variable clinical presentations and endoscopic findings, in addition to the nature of deep tissue injury is crucial in the management of such cases. Serial chest imaging and early referral to cardiothoracic surgery prevent progression into devastating consequences, like atrio-esophageal fistula (up to 93%). This patient's challenging clinical course exemplifies the need for a high index of suspicion and increased awareness of this elusive diagnosis.Figure 1" @default.
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- W2978017104 date "2016-10-01" @default.
- W2978017104 modified "2023-09-24" @default.
- W2978017104 title "Severe Debilitating Esophageal Dysphagia: A Rare Complication of Cardiac Radiofrequency Ablation" @default.
- W2978017104 doi "https://doi.org/10.14309/00000434-201610001-01605" @default.
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