Conclusion
Although the occurrence of AEF is low likelihood, the occurrence of esophageal injury related to AF ablation is quite frequent (about 15%). The concern for esophageal injury during AF ablation is a focus for electrophysiologists and has resulted in numerous steps to try to prevent injury: varied modalities used to identify the location/course of esophagus, continuous monitoring of esophageal luminal temperature with a variety of temperature monitoring systems, alteration of ablation techniques and energy delivery, and empiric use of proton pump inhibitors. Furthermore, the concern for AEF persists for a few weeks post ablation, resulting in the costly and worrisome clinical scenario of emergently excluding the presence of AEF in patients who present with symptoms post ablation.
Certainly a reliable method to protect the esophagus is of clinical value, but the ancillary value of reducing physician concern during AF ablation, reducing interruption to ablation work flow, perhaps enhancing AF ablation results34 and simplifying post procedure management of patient symptoms are also of high importance. Considering the ease of use, minimal side effects, and low costs associated with esophageal protection devices, these features offer compelling evidence for use of esophageal protection as routine care for AF ablation.
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