Excerpt

Surgical treatment for atrial fibrillation is still evolving. Tools are being developed to improve safety and efficacy. With new delivery platforms and devices, lesion sets can be delivered through minithoracotomy incisions, thoracoscopically, or using robotic assistance [1‐3]. Radiofrequency devices are available for transvenous catheter as well as surgical ablation. They are effective, but “collateral damage” to the esophagus and coronary arteries has been reported, and transmurality of lesions is not guaranteed [4]. High-intensity focused ultrasound (HIFU) has been developed in both transcatheter and surgical platforms to create transmural lesions while minimizing damage to the surrounding structures. There has, nonetheless, been a report of an atrioesophageal fistula following transcatheter HIFU pulmonary vein isolation [5]. Reported herein, is the first case of an esophageal injury following a surgical box lesion set using an epicardial HIFU device. …