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Background: HIFU can achieve PVI, but severe esophageal complications have happened. We analyzed relative position of HIFU balloon catheter (BC) to esophageal temperature (ET) probe and correlated it to ET changes. Methods and Results: Before each ablation relative position of HIFU BC to ET probe was recorded in RAO 30° and LAO 40°. We compared ablations where ET at end of ablation was <38.5°C or ≥38.5°C and <40.0°C or ≥40.0°C. A total of 600 images from 311 ablations in 28 patients (18 male, age 63±7 years), were analyzed. ET ≥38.5°C was reached when distance from BC to ET probe was: <20 mm in LAO for RSPV and <29 mm in LAO for RIPV. For RIPV ET ≥38.5°C was reached when angle between BC and ET probe was significantly smaller in LAO and RAO. ET ≥40.0°C was reached when distance of BC to ET probe was: <20 mm in LAO for RIPV, <14 mm in RAO for RIPV, <18 mm in RAO for LIPV. ET increased to ≥40.0°C when distance from BC to ET probe was significantly longer in LAO for LIPV. For RIPV ET ≥40.0°C was reached when angle between BC and ET probe was significantly smaller in LAO. Conclusions: There is a relationship between distance/angle of HIFU BC to ET probe and ET: shorter distances and smaller angles can cause higher ET.