Literally Heartburn: A Case Report Exploring Potential Preventive Measures of Esophageal Injury after Radiofrequency Ablation for Atrial Fibrillation

Esophageal injury (EI) after radiofrequency ablation (RF) for atrial fibrillation (AF) is a feared complication due to its extreme variability in presentation and very high mortality rate. The incidence of EI after RF ablation also varies widely among the literature. The diagnosis and management of EI is a combination of swift clinical recognition, confirmatory computed tomography (CT) imaging, and prompt surgical repair. This case discusses a 56-year-old male with past medical history of AF who presented to the hospital with complaints of chest pain, shortness of breath and nausea after undergoing recent RF ablation for AF. Imaging revealed an esophageal tear and he underwent surgical repair with creation of intercostal muscle flap. Various esophageal protective mechanisms may potentially reduce the incidence of EI. These mechanisms include variation in ablation techniques, esophageal temperature monitoring and esophageal cooling mechanisms.