{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T01:26:55Z","timestamp":1789522015619,"version":"build-2803163510"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2010,4]]},"abstract":"<jats:p>\n                    <jats:bold>\n                      <jats:italic>Background\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    Radiofrequency catheter ablation is increasingly used in the treatment of atrial fibrillation. Esophageal wall changes varying from erythema to ulcers have been described by endoscopy in up to 47% of patients following pulmonary vein isolation (PVI). Although esophageal changes are frequently reported, the development of a left atrial (LA)-esophageal fistula is fortunately rare. Nevertheless, mucosal changes may just represent \u201cthe tip of the iceberg.\u201d The aim of this study was, therefore, to investigate the more subtle changes of and injuries to the posterior wall of the LA, the periesophageal and mediastinal connective tissue, and the whole wall of the esophagus, including mucosal changes by esophagogastroduodenoscopy (EGD) combined with radial endosonography (EUS).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Methods and Results\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    Twenty-nine patients (7 females; mean age, 57.7\ufffd10.5 years [range, 23\u201375 years]) underwent EGD and EUS before and after PVI within 48 hours. PVI was performed as a circumferential antral isolation of the septal and lateral pulmonary veins guided by a decapolar circular mapping catheter using a 3-dimensional mapping system with the integration of a preprocedurally acquired computed tomography scan of the left atrium. The maximum power applied was 30 W, with an open-irrigated catheter using a maximum flow rate of 30 mL\/min. In all patients, the esophagus was reconstructed using the same computed tomography scan and displayed during the ablation procedure. In case of newly detected periesophageal changes, EGD and EUS were repeated 1 week after the PVI. In all patients, a regular contact area between the LA and the esophagus could be demonstrated before PVI. The mean vertical contact length was 4.4\ufffd1.5 cm (range, 2\u201310 cm); and the mean distance between the anterior wall of the esophagus and the endocardium was 2.6\ufffd0.8 mm (range, 1.4\u20134.0 mm). After PVI, morphological changes of the periesophageal connective tissue and the posterior wall of the LA were diagnosed by endosonography in 8 patients (27%; 95% confidence interval, 12.73\u201347.24). No mucosal changes of the esophagus in terms of erythema or ulcers were found. In all but one patient (who refused the control), all periesophageal and atrial changes had resolved within 1 week. No atrioesophageal fistula occurred during follow-up (mean follow-up, 294\ufffd110 days [range, 36\u2013431 days]).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Conclusions\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    Mucosal changes of the esophagus after PVI-like ulcers or erythema could not be demonstrated, yet structural changes of the mediastinum, which were only visible by endosonography, occurred in 27% of patients in the present study. This may indicate a higher than expected periesophageal injury because of PV ablation. Endosonography might prove to be a sensitive and reliable tool in the follow-up after PVI.\n                  <\/jats:p>","DOI":"10.1161\/circep.109.915918","type":"journal-article","created":{"date-parts":[[2010,3,1]],"date-time":"2010-03-01T23:55:37Z","timestamp":1267487737000},"page":"155-159","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":89,"title":["Damage to the Esophagus After Atrial Fibrillation Ablation"],"prefix":"10.1161","volume":"3","author":[{"given":"Stephan","family":"Zellerhoff","sequence":"first","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hansjo\u0308rg","family":"Ullerich","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Lenze","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Meister","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Wasmer","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerold","family":"Mo\u0308nnig","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Ko\u0308be","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Milberg","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Bittner","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Domschke","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gu\u0308nter","family":"Breithardt","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Eckardt","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology and Angiology (S.Z., K.W., G.M., J.K., P.M., A.B., G.B., L.E.) and the Department of Gastroenterology and Hepatology (H.U., F.L., T.M., W.D.), University Hospital of Muenster, Muenster, Germany; and the German Atrial Fibrillation Competence NETwork (G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.177292"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199809033391003"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eupc.2005.06.014"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.04.030"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2005.06.052"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/26\/5\/020"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-144-8-200604180-00007"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2003.165"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000131866.44650.46"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.104.509612"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eun001"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/circep.108.815266"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2006.06.006"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.8.931"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.20.644"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2003.12.023"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-1999-12"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2005.09.012"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1540-8167.2005.40560.x"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-005-0306-1"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2005.11.027"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2006.00674.x"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.08.042"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.03.058"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2005.00333.x"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2005.40825.x"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/circep.108.789552"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-008-9307-1"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2007.01068.x"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/circep.109.871939"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.109.915918","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T20:19:37Z","timestamp":1715545177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.109.915918"}},"subtitle":["Just the Tip of the Iceberg? High Prevalence of Mediastinal Changes Diagnosed by Endosonography"],"short-title":[],"issued":{"date-parts":[[2010,4]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2010,4]]}},"alternative-id":["10.1161\/CIRCEP.109.915918"],"URL":"https:\/\/doi.org\/10.1161\/circep.109.915918","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,4]]},"assertion":[{"value":"2010-03-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}