Introduction: Despite luminal esophageal temperature (LET) monitoring, esophageal injury remains a risk which impacts decision making during atrial fibrillation (AF) ablation. We sought to compare procedural characteristics including radiofrequency (RF) power, duration, and LET, among ablation procedures with and without visualization of esophageal segmentations relative to the left atrial dome. Hypothesis: We sought to test the hypothesis that esophageal image registration and visualization during AF ablation would improve operator efficiency and reduce esophageal temperature changes during the procedure. Methods: The retrospective cohort included 63 patients (mean age 65.5 ± 8.8 years, 33% female, 54% paroxysmal AF) that underwent pre-procedural cardiac magnetic resonance (CMR) and LET monitoring. Of all patients, 35 underwent standard AF ablation without esophageal image segmentation, and 28 underwent AF ablation with registration of esophageal image segmentation. Results: Total RF time was shorter with esophageal visualization (28.6 ± 11.8 min versus 39.1 ± 22.5 min, P<0.05). The distribution of ablation power delivery was skewed toward higher power with esophageal visualization (P<0.001), while the mean LET was identical among patient groups and the standard deviation of LET was lower in those with esophageal visualization (35.9 ± 0.5 °C versus 35.9 ± 0.7 °C, P=NS). The within patient standard deviation for LET change during posterior wall ablation was 0.3 ± 0.1 °C and 0.4 ± 0.2 °C for patients with and without esophageal visualization respectively (P=0.017). Conclusions: Esophageal visualization was associated with improved efficiency of AF ablation using higher power and resulting in shorter RF time, while reducing the variation in esophageal temperature.