Esophageal visualization changes atrial fibrillation ablation strategy: from encircling to segmental approach

A 78-year-old woman, with class I-A indication [1] for atrial fibrillation (AF) ablation, underwent radiofrequency pulmonary vein (PV) isolation for paroxysmal AF. A coronary CT angiography, performed before ablation for suspected coronary artery disease, depicted the left atrial anatomy, with a common left pulmonary vein trunk and the esophagus in close proximity to it (Fig. 1a). Esophageal electroanatomic mapping confirmed the esophagus leftward position in close contact with the common left PV trunk (Fig. 1b‐supplementary video). The electrophysiological study showed the presence of PV electrical potentials only in the roof and the anterior area of the left common trunk; therefore, we avoided ablation on the posterior wall that might have determined an increased risk of esophageal lesion, and delivered radiofrequency just on the PV potential areas. We achieved an acute procedural success performing a “segmental ostial ablation” [2]. This approach represented a tailored strategy. The patient was asymptomatic at 24-month follow-up, with drastic reduction of the AF burden (from 4 events/week before the procedure, to 0 reported sustained events).

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