Luminal esophageal temperature monitoring to reduce esophageal thermal injury during catheter ablation for atrial fibrillation: A review

Over the past decade, catheter ablation for atrial fibrillation has emerged as an important rhythm control strategy. One of the most dreaded complications of this procedure is atrio-esophageal (AE) fistula formation, which is relatively rare but usually fatal. Esophageal tissue injury during ablation appears to be a precursor to the formation of AE fistulae. Luminal esophageal temperature (LET) monitoring is one of the most commonly utilized strategies to mitigate this risk, despite little evidence that it reduces esophageal injury. The incidence of AE fistulae appears to be on the rise, despite the widespread use of LET monitoring. This may be due to the advent of improved large lesion technology including force-sensing catheters and the use of high power, although AE fistulae have also been observed with the use of low power along the left atrial posterior wall. Currently available discrete sensors probes, whether single or multiple, do not appear to significantly reduce injury rates. The purpose of this manuscript is to systematically review the incidence of esophageal thermal injury with and without LET monitoring and review the factors that may be associated with increased risk of injury