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Novel ablative approach for atrial fibrillation to decrease risk of esophageal injury

Published:November 08, 2007DOI:https://doi.org/10.1016/j.hrthm.2007.11.007
      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 thumbnail gr1
      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.

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