Longitudinal Esophageal Wall Rupture and Mediastinitis Due to Esophageal Warming Balloon Dysfunction During Left Atrial Ultralow Cryoablation for Persistent Atrial Fibrillation: A Case Report

Severe esophageal complications post-cryoablation remain rare but pose significant morbidity. In this case, overinflation of the esophageal warming device likely contributed to barotraumatic injury, worsening of esophageal fragility, leading to a major perforation with extensive mediastinitis. While protective devices aim to reduce ETI, their potential risks must be carefully considered. Optimal patient selection and refined protective strategies are crucial to enhancing procedural safety.