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Despite that, major complications are still reported, and esophageal thermal injury remains a significant concern as atrioesophageal fistula (AEF) is often fatal. Recognition of the mechanisms involved in the process of esophageal lesion formation and the identification of the main determinants of risk have set the grounds for the development and improvement of different esophageal protective strategies. More sensitive esophageal temperature monitoring, safer ablation parameters and catheters, and different energy sources appear to collectively reduce the risk of esophageal thermal injury. Adjunctive measures such as the prophylactic use of proton\u2010pump inhibitors, as well as esophageal cooling or deviation devices, have emerged as complementary methods with variable but promising results. Nevertheless, as a multifactorial problem, no single esophageal protective measure has proven to be sufficiently effective to eliminate the risk, and further investigation is still warranted. Early screening in the patients at risk and prompt intervention in the cases of AEF are important risk modifiers and yield better outcomes.<\/jats:p>","DOI":"10.1111\/jce.14513","type":"journal-article","created":{"date-parts":[[2020,4,23]],"date-time":"2020-04-23T05:30:00Z","timestamp":1587619800000},"page":"1364-1376","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Esophageal injury associated with catheter ablation for atrial fibrillation: Determinants of risk and protective strategies"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2605-0447","authenticated-orcid":false,"given":"Fabrizio R.","family":"Assis","sequence":"first","affiliation":[{"name":"Division of Cardiology Johns Hopkins University School of Medicine  Baltimore 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