Case Report
A 71-year-old female with symptomatic paroxysmal atrial fibrillation underwent cryoballoon PV isolation. BMI 28kg/m2 She presented medical history of hypertension. The transthoracic echocardiography detected moderately enlarged left atrium and transesophageal excluded a left atrial thrombus.
An 8-polar electrode catheter was inserted via right femoral access at starter followed by successful single transseptal puncture.The operator initiated the ablation respectively at all 4 PVs maneuvering the 28 mm balloon-catheter. 9 ablation applications were performed (Table 1) — 2 times on left superior pulmonary vein(LSPV),2 on left inferior pulmonary vein(LIPV), 2 on right superior pulmonary vein(RSPV), 3 on right inferior pulmonary vein(RIPV), lowest temperature of LIPV is -51℃. No additional RF ablations were supplemented. To maintain stable sinus rhythm,an external electrical cardioversion was performed at the endpoint of the ablation process, .
The following day the patients complained about dysphagia, and chest pain exacerbated by swallowing. Arrange the patient with post-procedural endoscopy which detected the esophageal thermal lesions(esophageal erosion accompanied by hematoma in the anterior wall of esophagus) . The patient predominantly underwent strict fasting and water deprivation,supported by intravenous nutritional liquids.The dose of proton-pump-inhibitor was increased to 40mg twice daily. The patients symptoms relieved progressively and 7th day after, we contact the same gastrointestinal physician to repeat the endoscopy, it showed the absolute recovery of esophageal mucosa(Figure 1). The patient was discharged the day after.
Table 1. Ablation duration time and balloon temperature