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Transesophageal echocardiography (TEE) has become a routine diagnostic tool. The use of TEE in clinical practice is diverse, extending from the intraoperative management of patients who undergo cardiac surgery, aortic surgery, lung transplantation, and liver transplantation,1–5 to emergent assessment of patients in the emergency room or intensive care unit,5,6 to the evaluation of left atrial appendage anatomy and function before cardioversion in patients with persistent atrial fibrillation (AF).7,8Article see p 701 Although TEE is a noninvasive diagnostic technique that is considered relatively safe across a broad spectrum of patients, severe life-threatening complications have been reported.5 The reported rates of major TEE-related complications range from 0.2% to 0.5%.5,9,10 Lennon et al11 examined patients for late complications and estimated a higher rate of gastrointestinal injuries of 1.2%. Mechanical injury to the esophageal and gastric body can lead to life-threatening bleeding. The estimated risk of significant gastrointestinal bleeding is 0.02% and 1.0%.10,11 Patients with friable mucosal tissue from underlying disease are at higher risk.5There are also distinct aspects of potential thermal injury in patients who undergo extensive ablation of the posterior left atrium for treatment of AF. Esophageal heating and potential injury can occur from piezoelectric crystal vibration within the TEE probe tip or by direct tissue heating from absorbed ultrasound energy.12 In addition, the TEE probe may also serve as a radiofrequency energy antenna and draw energy into the esophagus. This possibility, coupled with those previously mentioned, was raised in a large surgical series of left atrial ablation patients in which 1.3% developed …

Examining the Risks and Benefits of Transesophageal Echocardiogram Imaging During Catheter Ablation for Atrial Fibrillation