Discussion
The anatomic proximity of esophagus
to the LA especially the LIPV contributes to the formation of esophageal
thermal injury. It usually descends rear of the left atrium and slightly
right to the aorta, the encircled esophagus resembles a fountain
surrounded by the LIPV,spine and aorta.[6] During ablation procedure
at the LIPV,balloon occlusions extends the fast ice formation into the
PV itself. Therefore, when the balloon is placed deeper, collateral
damage, especially esophageal damage, will be more severe.[7] In our
case, the patient‘s left atrium was enlarged and esophagus was highly
adjacent to the LIPV which explains the esophageal lesions locating at
the anterior wall (Figure 2). A vast of approaches could be deployed to
evaluate the relationship between the esophagus and LA including
computerized tomography, intracardiac echocardiography(ICE). In
addition, during the operation, the relationship among the esophagus and
LA and the ablation catheter will not be stable, and the mechanical
pressure from the freezer balloon may compress the esophagus and shorten
the distance between the two,in order to obtain the relationship in real
time, the barium paste would be a suitable choice[8].