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Percutaneous atrial fibrillation (AF) ablation using catheter-delivered radiofrequency
energy continues to improve in safety and effectiveness. Nonetheless, the potential
risk of esophageal injury often limits the ability to fully ablate the posterior portion
of the left atrium to achieve optimal procedural success without complications. We
present a comprehensive approach that addresses this challenge. Our ablative strategies
include (1) identifying the esophagus to minimize ablative energy, when possible,
in the proximity of the esophagus, (2) maximize the ability of the esophagus to remove
heat and to heal from potential thermal injury, and (3) optimizing energy delivery
to avoid deep tissue injury while maintaining procedural efficacy. We present the
approach to these procedural strategies in two components: those performed prior to
and those applied during and after energy delivery (Figure 1).
Figure 1Technique summary and endpoints showing an ablative approach for atrial fibrillation
where ablation is delivered well outside of the pulmonary veins to decrease risk of
deep tissue heating and esophageal injury. ABL d = ablation catheter distal; ABL p
= ablation catheter proximal.
