Additional data on protection of the esophagus during catheter ablation of atrial fibrillation

The excellent review by Houmsse and Daoud of techniques and methods utilized to protect the esophagus from injury during atrial fibrillation (AF) ablation appropriately concludes that considering the ease of use, minimal side effects, and low costs associated with esophageal protection devices, compelling evidence exists for use of esophageal protection as routine care for AF ablation. Some additional data are available which would warrant inclusion in further consideration of this topic. Three recent studies have demonstrated the inability of LET monitoring to protect the esophagus, whereas meta-analysis of three studies of manual cooling using direct liquid instillation suggests that this approach significantly reduced high-grade lesion formation (OR of 0.39, 95% CI 0.17 to 0.89). Moreover, three studies using a commercially available cooling device FDA cleared for thermal regulation have shown reductions in esophageal lesion severity without degradation in ablation efficacy.