Strategies to Minimize the Risk of Esophageal Injury During Catheter Ablation for Atrial Fibrillation

Tristram D. Bahnson, M.D.


Pacing Clin Electrophysiol. 2009;32(2):248-260. 

In This Article

Complimentary imaging techniques are useful to identify when ablation target sites for treatment of atrial fibrillation are near the esophagus. Methods to monitor heat transfer to or thermal injury of the esophagus are limited. Alternative ablation strategies should be considered when endocardial ablation is indicated at sites near the esophagus. Whatever lesion set is chosen for therapeutic ablation, it seems most reasonable to limit, so much as possible, endocardial RF ablation adjacent to the esophagus. Hybrid therapy employing a combination of cryothermy for ablation near the esophagus and RF ablation at other endocardial sites is an option that has been used by several centers to achieve pulmonary vein isolation in patients with drug refractory AF. Although available large-tip cryothermy catheters are not labeled for endocardial ablation, and specific outcomes data are lacking, preliminary evidence suggests that cryothermy ablation may be a reasonable alternative to RF when endocardial ablation is required near the esophagus.

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