Mechanism of Injury
The exact mechanism of ablation injury to the esophagus is unclear and may be multifactorial. A common explanation is the direct effect of ablation energy resulting in injury to the esophagus – either with RF or cryo-ablation energy. Another potential mechanism is focal ischemia overlapping the site of ablation. Esophageal blood supply consists of arborizing arterial system over the surface of the esophagus. Ablation energy can result in ischemia due to occlusion of arteriole supply. Also, ablation energy can impact the vagal plexi over the esophagus resulting in gastroparesis with subsequent acid reflux.