Incidence of Transesophageal Echocardiography-Related Esophageal Mucosal Injury in Patients with Pulmonary Vein Isolation as a Treatment for Atrial Fibrillation

Introduction: Transesophageal echocardiography (TEE) is the gold standard modality for detecting a thrombus in the left atrium (LA) and the left atrial appendage (LAA) prior to pulmonary vein isolation (PVI) for the treatment of atrial fibrillation. Although TEE is has a good safety profile, it was recently reported that TEE preceding PVI can cause esophageal mucosal injury (EMI). However, the detailed data and mechanism of EMI by TEE remain to be elucidated. Herein, we investigated the incidence and risk factors of TEE-related EMI in patients who underwent PVI for AF. Methods: This study included 262 consecutive patients who underwent PVI with preoperative TEE using a 3D TEE probe and postoperative esophagogastroduodenoscopy. The cause of EMI was classified by an experienced gastroenterologist. Results: TEE-related EMI was found in 16 (6.1%) patients, whereas PVI-related EMI was found in 5 (1.9%) patients. Only one patient with TEE-related EMI experienced mild chest discomfort. In the multivariate analysis, advanced age was an independent risk factor for TEE-related EMI (odds ratio, 1.08 per 1-year increment; 95% confidence interval, 1.01-1.16; p = 0.0274). Conclusions: The incidence of TEE-related EMI, for which advanced age could be a significant risk factor, using a 3D TEE probe was relatively high in patients who underwent PVI. This study suggests that attention should be paid to the indications of TEE before performing PVI, especially in elderly patients, and other modalities for ruling out LA and LAA thrombus should also be considered.