PMC:6019327 / 303308-304600 JSONTXT

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In order to minimize injury to the esophagus during RF applications on the posterior wall close to the esophagus, several approaches can be employed, including (1) reduction of RF power (e.g., ≤25 W); (2) shortening RF application time (e.g., ≤20 seconds); and/or (3) decreasing CF (e.g., ≤10 grams). The writing group recommends that RF power be reduced when creating lesions along the posterior wall near the esophagus (Class I, LOE C-LD, Table 3). Some reports employed the use of light conscious sedation to use pain to identify potential esophageal injury. However, there are conflicting data on the specificity of the pain response. It has been proposed that an alternative energy source, such as the CB for PVI, could minimize esophageal injury877,878; however, AEF or periesophageal vagal plexus injury after CBA has been reported.879,880 There are also data that other heat-based energy sources, such as high-intensity focused ultrasound or laser energy, can damage the esophagus.501,502,700,701,705,881 Although each of these approaches is variously adopted by different ablation centers, each remains largely unproven due to the rarity of an AEF as a complication."}