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.