How to demonstrate factors associated with peri-esophageal vagal nerve injury during catheter ablation for atrial fibrillation

Peri-esophageal vagal nerve injury (PNI) can unpredictably occur during atrial fibrillation ablation procedures. Yoshimura and colleagues have demonstrated an association between symptomatic PNI and high contact force near the esophagus.¹ However, several concerns have been raised.

While the authors identify contact force as a major cause of PNI,¹ other factors such as baseline impedance and the rate of rise of esophageal temperature during ablation have also been proposed.^{2, 3}

The authors limited ablation power to <30 W and ablation duration to within 30 s, irrespective of the ablation index, when ablating the left atrial posterior wall near the esophagus.¹ Ablation was terminated promptly if the esophageal temperature reached 40°C. Nevertheless, recent literature indicates that high-power short-duration ablation may offer advantages over moderate-power moderate-duration ablation, including improved durability of ablation, reduced procedure time, and decreased risk of irreversible tissue injury.⁴ Additionally, concerns persist regarding the optimal placement of ablation lines on the left atrial posterior wall to prevent PNI.

In the current era, moderate-power ablation, as employed by the authors, is seldom the initial choice. Instead, cryoballoon and pulsed-field ablations are preferred. How do the authors' findings translate to contemporary procedures?

None.

Authors declare no conflict of interests for this article.

None.