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.
