Esophageal Cooling During Radiofrequency Ablation: Can Opposite (Strategies) Attract?

Abstract

Catheter ablation has become the standard of care for the management of antiarrhythmic drug-refractory atrial fibrillation (AF) in many patients. The cornerstone of AF ablation includes pulmonary vein isolation (PVI) and energy delivery can sometimes extend beyond the atrial myocardium and result in collateral damage to adjacent structures, include the esophagus.[1] While atrial esophageal fistula (AEF) is a generally a rare complication, there have been continued efforts aimed to reduce esophageal thermal injury during AF ablation. While emerging energy sources such as irreversible electroporation show exciting promise for selective, non-thermal targeting of myocardial tissue, safety and efficacy clinical trial evaluation is on-going.[2] Therefore, strategies that can prevent esophageal thermal injury without adversely impacting lesion formation using conventional ablation technologies are still needed.