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Updated: Feb 8, 2026

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation
Published on: March 15, 2020
Extracardiac ice formation during CoolLoop cryoablation of atrial fibrillation
Carlo de Asmundis1, Gian-Battista Chierchia1, Marc La Meir2
1Heart Rhythm Management Centre, Postgraduate Program Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Vrije Universitet Brussel, Brussels, Belgium.
Abstract:
A 75-year-old male patient was referred for longstanding atrial fibrillation ablation. We performed this procedure combining an epicardial and endocardial approach. Under general anesthesia and via a left-sided thoracoscopic approach, we isolated the pulmonary veins (PVs) and the roofline and inferior line were created using a radiofrequency tool. To isolate the endocardial PVs, a transseptal puncture was performed via the groin, and a cryoablation CoolLoop catheter (AFreeze GmbH, Innsbruck, Austria) was advanced into the left atrium. Ice crystals started to appear on the epicardial surface of the left inferior PV antrum after 121 seconds later, those crystals had formed an ice plaque. For the first time in humans, we were able to visualize the transmural effects of cryothermal energy ablation via a CoolLoop catheter on the epicardial surface of the ostium of the PV.
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