Perspective:

Esophageal injury during AF ablation is common in virtually all types of ablation energy sources, save for the emerging pulse field ablation, although the instances of life-threatening atrio-esophageal fistula is indeed very low. Esophageal temperature monitoring during ablation, shortened duration of power, and perioperative proton pump inhibitor use have emerged as the main measures aimed at the reduction of esophageal injury. Prior reports of esophageal retractors have shown the feasibility of the approach, but the retractors were limited by the inability of the device to move the training edge of the esophagus. The present report shows that the new study device using deflection and suction can effectively move both the leading and the trailing edge of the esophagus with less esophageal injury observed on endoscopy 1-day post-ablation in those patients in whom it was used. Of note, the study was terminated early after only 120 patients had been enrolled. The electrophysiology proceduralist was not blinded to the randomization and may have altered the ablation strategy to avoid esophageal injury.