Published online May 14, 2017. doi: 10.3748/wjg.v23.i18.3374
Peer-review started: November 24, 2016
First decision: December 28, 2016
Revised: January 18, 2017
Accepted: February 7, 2017
Article in press: February 8, 2017
Published online: May 14, 2017
Various degrees of esophageal injury have been described after radiofrequency ablation performed for treatment of atrial fibrillation. The main mechanism of injury is thermal and may lead to a range of esophageal mucosal changes, some clinically insignificant, however when deep ulceration occurs, this may be further complicated by perforation and mediastinitis, a rare but life threatening sequelae. We present a case of a severe esophageal injury leading to mediastinitis, with interesting endoscopic findings.
Core tip: We report a case of esophageal perforation complicated by mediastinitis. Our report demonstrates the clinical course of a rare, yet deadly complication of radiofrequency ablation, with unique endoscopic findings. We believe that this report and brief review of the literature will serve an important reminder of this complication and its consequences, requiring a high index of suspicion for early diagnosis and treatment. Our report also serves as a reminder that a unified approach to treatment has yet to be established.