主动食管冷却的目的是减少射频（RF）心脏消融手术引起的消融相关食管损伤的可能性，这种方法越来越多地被使用，并且已被美国食品和药物管理局批准作为左心房射频消融治疗期间的保护策略。心房颤动。在这篇综述中，我们研究了支持使用主动食管冷却的证据以及降低房食管瘘（AEF）形成可能性的潜在作用机制。尽管射频消融热损伤后 AEF 形成背后的病理生理学尚未得到充分研究，但存在关于其他情况（例如克罗恩病、癌症和创伤）中瘘管形成的可靠文献，并且本综述研究了与 AEF 形成的关系。同样，我们研究了外科文献中有关烧伤和热损伤进展以及冷却的急性和慢性缓解作用的大量数据。我们讨论这些数据和适应不良愈合机制与射频消融后公认的消融后病理生理效应的关系。最后，我们回顾了其他重要的考虑因素，例如患者选择、临床工作流程和主动食管冷却的实施策略。© 2024 Heart Rhythm Society。由爱思唯尔公司出版

Proactive esophageal cooling for the purpose of reducing the likelihood of ablation-related esophageal injury resulting from radiofrequency (RF) cardiac ablation procedures is increasingly being used and has been Food and Drug Administration cleared as a protective strategy during left atrial RF ablation for the treatment of atrial fibrillation. In this review, we examine the evidence supporting the use of proactive esophageal cooling and the potential mechanisms of action that reduce the likelihood of atrioesophageal fistula (AEF) formation. Although the pathophysiology behind AEF formation after thermal injury from RF ablation is not well studied, a robust literature on fistula formation in other conditions (eg, Crohn disease, cancer, and trauma) exists and the relationship to AEF formation is investigated in this review. Likewise, we examine the abundant data in the surgical literature on burn and thermal injury progression as well as the acute and chronic mitigating effects of cooling. We discuss the relationship of these data and maladaptive healing mechanisms to the well-recognized postablation pathophysiological effects after RF ablation. Finally, we review additional important considerations such as patient selection, clinical workflow, and implementation strategies for proactive esophageal cooling.© 2024 Heart Rhythm Society. Published by Elsevier Inc.