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.