{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T15:21:41Z","timestamp":1777735301837,"version":"3.51.4"},"reference-count":15,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Atrial fibrillation (AF) is a common supraventricular tachyarrhythmia associated with an increased risk of stroke and mortality. Catheter ablation using pulmonary vein isolation is a standard treatment for patients refractory to antiarrhythmic drugs, where radiofrequency ablation and cryoablation are the two most commonly used procedures. Although generally safe, esophageal baro\u2010 and thermal injuries remain a rare but life\u2010threatening complication due to the close anatomical relationship between the esophagus and the left atrium. Various protective strategies, such as esophageal temperature monitoring and displacement, aim to mitigate this risk, yet their efficacy and safety are still under investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 72\u2010year\u2010old male with persistent AF underwent cryoablation with an esophageal warming device to prevent esophageal thermal injury. Despite an uneventful procedure, postoperatively, the patient developed severe thoracic pain. Imaging revealed esophageal perforation with active bleeding. Conservative management, including nil per os, antibiotics, and drainage, was initially pursued. However, worsening clinical status necessitated thoracoscopic intervention. Findings included extensive hematoma and inflammation, precluding primary repair. Conservative treatment with enteral nutrition and drainage led to gradual improvement, and the patient was discharged on Day 24. Follow\u2010up confirmed near\u2010complete healing, with no recurrence of AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Severe esophageal complications post\u2010cryoablation 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70274","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T04:14:56Z","timestamp":1769746496000},"page":"669-673","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Esophageal Wall Rupture and Mediastinitis Due to Esophageal Warming Balloon Dysfunction During Left Atrial Ultralow Cryoablation for Persistent Atrial Fibrillation: A Case Report"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9340-0836","authenticated-orcid":false,"given":"Roza","family":"Makarian","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery University Hospital Leuven Leuven Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7054-2411","authenticated-orcid":false,"given":"Ward","family":"Seurs","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery University Hospital Leuven Leuven Belgium"},{"name":"KU Leuven, Department of Chronic Diseases and Metabolism (CHROMETA) Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1145-4812","authenticated-orcid":false,"given":"Philippe","family":"Nafteux","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery University Hospital Leuven Leuven Belgium"},{"name":"KU Leuven, Department of Chronic Diseases and Metabolism (CHROMETA) Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1153-8298","authenticated-orcid":false,"given":"Hans","family":"Van Veer","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery University Hospital Leuven Leuven Belgium"},{"name":"KU Leuven, Department of Chronic Diseases and Metabolism (CHROMETA) Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0877-7717","authenticated-orcid":false,"given":"Herbert","family":"Decaluw\u00e9","sequence":"additional","affiliation":[{"name":"Department of Vascular and Thoracic Surgery Hospital East\u2010Limburg Genk Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8230-5649","authenticated-orcid":false,"given":"Lieven","family":"Depypere","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery University Hospital Leuven Leuven Belgium"},{"name":"KU Leuven, Department of Chronic Diseases and Metabolism (CHROMETA) Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2016-309781"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.0335"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602014"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.025827"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.31083\/j.rcm2303112"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15724"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2022.05.017"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.12.053"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaa276"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13015"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.551291"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2022.02.015"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.12575"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-024-03114-3"}],"container-title":["Journal 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