Main findings
We visualized and located the esophagus and measured LAPW thickness, focusing on the thickness adjacent to the esophagus, by ICE with the use of CartoSoundstar catheter inserted to the LA cavity. We could create and confirm the visualized 3D esophagus image accurately in a real-time fashion during the AF ablation procedure. In addition, we found that LAPW thickness was thinner than the LA roof thickness and different among the 4 height levels at LSPV, carina, LIPV and LIPV bottom. It is noteworthy that LAPW thickness at the carina, LIPV and LIPV bottom level was <3mm in the vast majority and was only 1.9 mm (median) at the LIPV level. To the best of our knowledge, this is the first study assessing LAPW thickness adjacent to the esophagus with ICE from the LA cavity. AI-guide ablation using a relatively low target value 260 on the esophagus region seems to be effective PVI.