Other Considerations
The risk of atrioesophageal fistula remains a major concern with
endocardial ablation involving the left atrial posterior wall.
Endocardial ablation of non-paroxysmal atrial fibrillation often
involves significant energy application in the vicinity of the
esophagus, particularly when complete isolation of the posterior wall is
a goal. Esophageal temperature monitoring is routinely used, but
guidelines for acceptable temperature deviation are lacking. Further,
evidence that temperature monitoring prevents esophageal injury is
limited, as evidenced by the continued incidence of this terrible
complication. The Hybrid Convergent procedure benefits from a unique
catheter design which directs energy away from the esophagus and toward
the epicardial left atrial posterior wall. In addition, the pericardial
space is irrigated with saline during energy application. Far less
endocardial ablation is required near the posterior wall to complete the
lesion set. These factors result in less esophageal heating, and
presumable a lower risk of esophageal injury. The ability of the
Convergent procedure to provide durable transmural left atrial posterior
wall isolation while minimizing risk of esophageal injury may be an
important consideration in patient selection.