Other Methods to Avoid Esophageal Injury
- High Power / Short Duration
High-power/short duration (HPSD) RFA has been increasingly utilized
during left atrial posterior wall ablation since its biophysics
relatively depends on resistive heating rather than conductive heating.
Therefore, esophageal injury is presumably less likely compared to
conventional RFA38. Nevertheless, a recent study
showed significant increase in LET if HPSD RFA lesions performed less
than 20mm from the temperature sensor39. There was no
endoscopy performed to confirm safety of HPSD ablation. However,
additionally, a recent meta-analysis reported no difference in
esophageal injury with HPSD compared to conventional
RFA40. To date, therefore, there is no data to suggest
that HPSD offers an ablation strategy to reduce esophageal injury.
- Pulse-Field Ablation
Pulse-field ablation (PFA) has been applied in AF ablation. The
advantage of PFA is that it creates myocardial tissue-specific death by
forming micropores in the cell membrane, without risk of injury to
collateral structures, including esophageal tissue. PFA efficacy and
safety was evaluated in 81 patients who underwent successful pulmonary
vein isolation. There was no esophageal injury in 25 patients who
underwent post PFA endoscopy41.