Key result
Esophageal cooling protects against injury during AF ablation, whereas temperature monitoring lacks supporting evidence.
Why the study?
Injury to adjacent non-cardiac structures causes severe complications during persistent AF ablation, but avoiding injury by limiting energy can impede procedural effectiveness.
What are the available methods to avoid injury to extracardiac structures during endocardial ablation for persistent atrial fibrillation?
What are the available methods to avoid injury to extracardiac structures during endocardial ablation for persistent atrial fibrillation?
Active esophageal cooling and emerging technologies like pulsed field ablation offer promising strategies to prevent lethal collateral damage such as atrio-oesophageal fistulas during AF ablation, whereas traditional temperature monitoring lacks supportive evidence.
May guide safer AF ablation by favoring esophageal cooling; leaves open optimal protocols pending prospective trials.
Injury to structures adjacent to the heart, particularly oesophageal injury, accounts for a large proportion of fatal and life-altering complications of ablation for persistent AF. Avoiding these complications dictates many aspects of the way ablation is performed. Because avoidance involves limiting energy delivery in areas of interest, fear of extracardiac injury can impede the ability of the operator to perform an effective procedure. New techniques are becoming available that may permit the operator to circumvent this dilemma and deliver effective ablation with less risk to adjacent structures. The authors review all methods available to avoid injury to extracardiac structures to put these developments in context.
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Leung et al. (2022) conducted a review in Persistent Atrial Fibrillation. Methods to avoid extracardiac injury during endocardial ablation was evaluated. Methods to avoid extracardiac injury during endocardial ablation for atrial fibrillation include esophageal cooling, which provides effective protection during RF ablation, while traditional temperature monitoring lacks supporting evidence.
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