PMC:6019327 / 323460-325960 JSONTXT

{"project":"2_test","denotations":[{"id":"28506916-24903064-29308602","span":{"begin":255,"end":258},"obj":"24903064"},{"id":"28506916-24903064-29308602","span":{"begin":255,"end":258},"obj":"24903064"},{"id":"28506916-15159294-29308603","span":{"begin":259,"end":262},"obj":"15159294"},{"id":"28506916-15159294-29308603","span":{"begin":259,"end":262},"obj":"15159294"},{"id":"28506916-25066237-29308604","span":{"begin":263,"end":266},"obj":"25066237"},{"id":"28506916-25066237-29308604","span":{"begin":263,"end":266},"obj":"25066237"},{"id":"28506916-19463436-45814858","span":{"begin":1237,"end":1240},"obj":"19463436"},{"id":"28506916-19463436-45814858","span":{"begin":1237,"end":1240},"obj":"19463436"},{"id":"28506916-27174109-45814859","span":{"begin":1241,"end":1244},"obj":"27174109"},{"id":"28506916-27174109-45814859","span":{"begin":1241,"end":1244},"obj":"27174109"},{"id":"T85494","span":{"begin":255,"end":258},"obj":"24903064"},{"id":"T59702","span":{"begin":255,"end":258},"obj":"24903064"},{"id":"T90443","span":{"begin":259,"end":262},"obj":"15159294"},{"id":"T6654","span":{"begin":259,"end":262},"obj":"15159294"},{"id":"T34109","span":{"begin":263,"end":266},"obj":"25066237"},{"id":"T85794","span":{"begin":263,"end":266},"obj":"25066237"},{"id":"T9916","span":{"begin":1237,"end":1240},"obj":"19463436"},{"id":"T24247","span":{"begin":1237,"end":1240},"obj":"19463436"},{"id":"T88921","span":{"begin":1241,"end":1244},"obj":"27174109"},{"id":"T12026","span":{"begin":1241,"end":1244},"obj":"27174109"},{"id":"T99179","span":{"begin":255,"end":258},"obj":"24903064"},{"id":"T54610","span":{"begin":255,"end":258},"obj":"24903064"},{"id":"T25490","span":{"begin":259,"end":262},"obj":"15159294"},{"id":"T63084","span":{"begin":259,"end":262},"obj":"15159294"},{"id":"T576","span":{"begin":263,"end":266},"obj":"25066237"},{"id":"T10","span":{"begin":263,"end":266},"obj":"25066237"},{"id":"T78096","span":{"begin":1237,"end":1240},"obj":"19463436"},{"id":"T96371","span":{"begin":1237,"end":1240},"obj":"19463436"},{"id":"T31545","span":{"begin":1241,"end":1244},"obj":"27174109"},{"id":"T99922","span":{"begin":1241,"end":1244},"obj":"27174109"}],"text":"Late symptoms of dysphagia and/or fever, particularly in the presence gastrointestinal bleeding or any neurological symptoms, should prompt an urgent evaluation for an AEF, a rare but potentially lethal complication after AF ablation (see Section 10).341,417,866,910 If AEF is suspected, esophagogastroduodenoscopy should not be performed, because increased pressure in the esophagus can lead to the introduction of air into the LA and stroke. Imaging with CT or MR is preferred, with the presence of air in the mediastinum or LA considered diagnostic. Although barium should not be introduced into the esophagus, a small amount of water-soluble contrast can help identify the location of the fistula. The recommended treatment for AEF at any stage is surgical exploration and resection of the fistulae, typically requiring resection of the involved esophagus and repair of the posterior LA wall with a pericardial patch. There have been reports of treatment of early fistulae with covered esophageal stents; however, surgical treatment is generally preferred. A persistent cough \u003e6 weeks after ablation, particularly if associated with atypical chest pain, recurrent pneumonia or hemoptysis, should prompt an evaluation for PV stenosis.927,928 A chest roentgenogram might also show evidence of atelectasis or infiltrate localized to one lobe of the lung, which is typically related to focal pulmonary edema. Many patients have received repeated courses of antibiotics for lung infection before the correct diagnosis is reached. If PV stenosis is suspected, a chest contrast CT angiogram or MR angiogram should be performed to examine PV anatomy and exclude PV stenosis or occlusion. If PV stenosis or occlusion is detected, a ventilation or perfusion scan is typically performed to quantify lung perfusion. Referral to a center with expertise in PV stenting should be recommended early in the course of PV stenosis, because dilatation is more difficult and has a higher incidence of pulmonary hypertension, lung infarct, and hemoptysis once high grade stenosis has occurred (see Section 10: Complications). Hemoptysis should trigger an evaluation for PV stenosis and usually indicates the presence of complete branch or PV occlusion. Other late complications include a stroke or embolic event related to recurrent AF or deep vein thrombosis or pulmonary embolus related to femoral vein instrumentation. These complications are uncommon because anticoagulation is typically reinstated after ablation."}