Patient selection: radiofrequency catheter ablation of atrial fibrillation
Risk factors:
(1) deep esophageal ulceration following the procedure
(2) failure to have limits on power or duration of radiofrequency applications
(3) operator inexperience
(4) temperature >= 39°C with an intraesophageal temperature probe during the procedure
Onset of symptoms is 1-6 weeks after the procedure
Clinical features may include:
(1) fever
(2) malaise
(3) dysphagia
(4) chest pain
(5) hemoptysis
(6) neurologic symptoms secondary to micro-emboli
(6a) due to air emboli
(6b) due to infective endocarditis
Laboratory findings may include:
(1) variable positive blood cultures (often with oral flora)
Imaging studies may show:
(1) air in the atrium
(2) vegetations on a heart valve
(3) fistula tract
