A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study

Roland Richard Tilz; Vanessa Schmidt; Helmut Pürerfellner; Philippe Maury; K. R. Julian Chun; Martin Martinek; Christian Sohns; Boris Schmidt; Franck Mandel; Estelle Gandjbakhch; Mikael Laredo; Melanie Anuscha Gunawardene; Stephan Willems; Thomas Beiert; Martin Borlich; Leon Iden; Anna Füting; Raphael Spittler; Thomas Gaspar; Sergio Richter; Anja Schade; Malte Kuniss; Thomas Neumann; Alexander Francke; Carsten Wunderlich; Dong In Shin; Dirk Grosse Meininghaus; Mike Foresti; Marc Bonsels; David Reek; Uwe Wiegand; Alexander Bauer; Andreas Metzner; Lars Eckardt; Sorin Stefan Popescu; Olaf Krahnefeld; Christian Sticherling; Michael Kühne; Dinh Quang Nguyen; Laurent Roten; Ardan M. Saguner; Dominik Linz; Pepijn Van Der Voort; Bart A. Mulder; Johan Vijgen; Alexandre Almorad; Charles Guenancia; Laurent Fauchier; Serge Boveda; Y. De Greef; Antoine Da Costa; Pierre Jais; Nicolas Derval; Antoine Milhem; Laurence Jesel; Rodrigue Garcia; Hervé Poty; Ziad Khoueiry; Julien Seitz; Julien Laborderie; Alexis Mechulan; Francois Brigadeau; Alexandre Zhao; Yannick Saludas; Olivier Piot; Nikhil Ahluwalia; Claire Martin; Jian Chen; Bor Antolic; Georgios Leventopoulos; Emin Evren Özcan; Hikmet Yorgun; Serkan Cay; Kivanc Yalin; Maichel Sobhy Botros; Ahmed Taher Mahmoud; Ewa Jȩdrzejczyk-Patej; Osamu Inaba; Ken Okumura; Koichiro Ejima; Houman Khakpour; Noel Boyle; John N. Catanzaro; Vivek Reddy; Sanghamitra Mohanty; Andrea Natale; Hermann Blessberger; Bing Yang; Irene Stevens; Philipp Sommer; Christian Veltmann; Daniel Steven; Julia Vogler; Karl Heinz Kuck; José Luis Merino; Ahmad Keelani; Christian H. Heeger

doi:10.1093/eurheartj/ehad250

A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study

Roland Richard Tilz^*, Vanessa Schmidt, Helmut Pürerfellner, Philippe Maury, K. R. Julian Chun, Martin Martinek, Christian Sohns, Boris Schmidt, Franck Mandel, Estelle Gandjbakhch, Mikael Laredo, Melanie Anuscha Gunawardene, Stephan Willems, Thomas Beiert, Martin Borlich, Leon Iden, Anna Füting, Raphael Spittler, Thomas Gaspar, Sergio RichterAnja Schade, Malte Kuniss, Thomas Neumann, Alexander Francke, Carsten Wunderlich, Dong In Shin, Dirk Grosse Meininghaus, Mike Foresti, Marc Bonsels, David Reek, Uwe Wiegand, Alexander Bauer, Andreas Metzner, Lars Eckardt, Sorin Stefan Popescu, Olaf Krahnefeld, Christian Sticherling, Michael Kühne, Dinh Quang Nguyen, Laurent Roten, Ardan M. Saguner, Dominik Linz, Pepijn Van Der Voort, Bart A. Mulder, Johan Vijgen, Alexandre Almorad, Charles Guenancia, Laurent Fauchier, Serge Boveda, Y. De Greef, Antoine Da Costa, Pierre Jais, Nicolas Derval, Antoine Milhem, Laurence Jesel, Rodrigue Garcia, Hervé Poty, Ziad Khoueiry, Julien Seitz, Julien Laborderie, Alexis Mechulan, Francois Brigadeau, Alexandre Zhao, Yannick Saludas, Olivier Piot, Nikhil Ahluwalia, Claire Martin, Jian Chen, Bor Antolic, Georgios Leventopoulos, Emin Evren Özcan, Hikmet Yorgun, Serkan Cay, Kivanc Yalin, Maichel Sobhy Botros, Ahmed Taher Mahmoud, Ewa Jȩdrzejczyk-Patej, Osamu Inaba, Ken Okumura, Koichiro Ejima, Houman Khakpour, Noel Boyle, John N. Catanzaro, Vivek Reddy, Sanghamitra Mohanty, Andrea Natale, Hermann Blessberger, Bing Yang, Irene Stevens, Philipp Sommer, Christian Veltmann, Daniel Steven, Julia Vogler, Karl Heinz Kuck, José Luis Merino, Ahmad Keelani, Christian H. Heeger^*

^*Corresponding author for this work

27 Citations (Scopus)

Abstract

Aims: Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse. Methods and results: This international multicentre registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553 729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed, at 214 centres in 35 countries. In 78 centres 138 patients [0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (P < 0.0001)] were diagnosed with an oesophageal fistula. Peri-procedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8% and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) [odds ratio 7.463 (2.414, 23.072) P < 0.001]. Conclusion: Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.

Original language	English
Journal	European Heart Journal
Volume	44
Issue number	27
Pages (from-to)	2458-2469
Number of pages	12
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehad250
Publication status	Published - 14.07.2023

Research Areas and Centers

Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

205-12 Cardiology, Angiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/eurheartj/ehad250

Cite this

Tilz, R. R., Schmidt, V., Pürerfellner, H., Maury, P., Julian Chun, K. R., Martinek, M., Sohns, C., Schmidt, B., Mandel, F., Gandjbakhch, E., Laredo, M., Gunawardene, M. A., Willems, S., Beiert, T., Borlich, M., Iden, L., Füting, A., Spittler, R., Gaspar, T., ... Heeger, C. H. (2023). A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study. European Heart Journal, 44(27), 2458-2469. https://doi.org/10.1093/eurheartj/ehad250

@article{62310213fc824e638c650f0b68e72876,

title = "A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study",

abstract = "Aims: Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse. Methods and results: This international multicentre registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553 729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed, at 214 centres in 35 countries. In 78 centres 138 patients [0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (P < 0.0001)] were diagnosed with an oesophageal fistula. Peri-procedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8% and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) [odds ratio 7.463 (2.414, 23.072) P < 0.001]. Conclusion: Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.",

author = "Tilz, {Roland Richard} and Vanessa Schmidt and Helmut P{\"u}rerfellner and Philippe Maury and {Julian Chun}, {K. R.} and Martin Martinek and Christian Sohns and Boris Schmidt and Franck Mandel and Estelle Gandjbakhch and Mikael Laredo and Gunawardene, {Melanie Anuscha} and Stephan Willems and Thomas Beiert and Martin Borlich and Leon Iden and Anna F{\"u}ting and Raphael Spittler and Thomas Gaspar and Sergio Richter and Anja Schade and Malte Kuniss and Thomas Neumann and Alexander Francke and Carsten Wunderlich and Shin, {Dong In} and Meininghaus, {Dirk Grosse} and Mike Foresti and Marc Bonsels and David Reek and Uwe Wiegand and Alexander Bauer and Andreas Metzner and Lars Eckardt and Popescu, {Sorin Stefan} and Olaf Krahnefeld and Christian Sticherling and Michael K{\"u}hne and Nguyen, {Dinh Quang} and Laurent Roten and Saguner, {Ardan M.} and Dominik Linz and {Van Der Voort}, Pepijn and Mulder, {Bart A.} and Johan Vijgen and Alexandre Almorad and Charles Guenancia and Laurent Fauchier and Serge Boveda and Greef, {Y. De} and {Da Costa}, Antoine and Pierre Jais and Nicolas Derval and Antoine Milhem and Laurence Jesel and Rodrigue Garcia and Herv{\'e} Poty and Ziad Khoueiry and Julien Seitz and Julien Laborderie and Alexis Mechulan and Francois Brigadeau and Alexandre Zhao and Yannick Saludas and Olivier Piot and Nikhil Ahluwalia and Claire Martin and Jian Chen and Bor Antolic and Georgios Leventopoulos and {\"O}zcan, {Emin Evren} and Hikmet Yorgun and Serkan Cay and Kivanc Yalin and Botros, {Maichel Sobhy} and Mahmoud, {Ahmed Taher} and Ewa Jȩdrzejczyk-Patej and Osamu Inaba and Ken Okumura and Koichiro Ejima and Houman Khakpour and Noel Boyle and Catanzaro, {John N.} and Vivek Reddy and Sanghamitra Mohanty and Andrea Natale and Hermann Blessberger and Bing Yang and Irene Stevens and Philipp Sommer and Christian Veltmann and Daniel Steven and Julia Vogler and Kuck, {Karl Heinz} and Merino, {Jos{\'e} Luis} and Ahmad Keelani and Heeger, {Christian H.}",

note = "Publisher Copyright: {\textcopyright} 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2023",

month = jul,

day = "14",

doi = "10.1093/eurheartj/ehad250",

language = "English",

volume = "44",

pages = "2458--2469",

journal = "European Heart Journal",

issn = "0195-668X",

number = "27",

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Tilz, RR, Schmidt, V, Pürerfellner, H, Maury, P, Julian Chun, KR, Martinek, M, Sohns, C, Schmidt, B, Mandel, F, Gandjbakhch, E, Laredo, M, Gunawardene, MA, Willems, S, Beiert, T, Borlich, M, Iden, L, Füting, A, Spittler, R, Gaspar, T, Richter, S, Schade, A, Kuniss, M, Neumann, T, Francke, A, Wunderlich, C, Shin, DI, Meininghaus, DG, Foresti, M, Bonsels, M, Reek, D, Wiegand, U, Bauer, A, Metzner, A, Eckardt, L, Popescu, SS, Krahnefeld, O, Sticherling, C, Kühne, M, Nguyen, DQ, Roten, L, Saguner, AM, Linz, D, Van Der Voort, P, Mulder, BA, Vijgen, J, Almorad, A, Guenancia, C, Fauchier, L, Boveda, S, Greef, YD, Da Costa, A, Jais, P, Derval, N, Milhem, A, Jesel, L, Garcia, R, Poty, H, Khoueiry, Z, Seitz, J, Laborderie, J, Mechulan, A, Brigadeau, F, Zhao, A, Saludas, Y, Piot, O, Ahluwalia, N, Martin, C, Chen, J, Antolic, B, Leventopoulos, G, Özcan, EE, Yorgun, H, Cay, S, Yalin, K, Botros, MS, Mahmoud, AT, Jȩdrzejczyk-Patej, E, Inaba, O, Okumura, K, Ejima, K, Khakpour, H, Boyle, N, Catanzaro, JN, Reddy, V, Mohanty, S, Natale, A, Blessberger, H, Yang, B, Stevens, I, Sommer, P, Veltmann, C, Steven, D, Vogler, J, Kuck, KH, Merino, JL, Keelani, A & Heeger, CH 2023, 'A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study', European Heart Journal, vol. 44, no. 27, pp. 2458-2469. https://doi.org/10.1093/eurheartj/ehad250

A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study. / Tilz, Roland Richard; Schmidt, Vanessa; Pürerfellner, Helmut et al.
In: European Heart Journal, Vol. 44, No. 27, 14.07.2023, p. 2458-2469.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation

T2 - The POTTER-AF study

AU - Tilz, Roland Richard

AU - Schmidt, Vanessa

AU - Pürerfellner, Helmut

AU - Maury, Philippe

AU - Julian Chun, K. R.

AU - Martinek, Martin

AU - Sohns, Christian

AU - Schmidt, Boris

AU - Mandel, Franck

AU - Gandjbakhch, Estelle

AU - Laredo, Mikael

AU - Gunawardene, Melanie Anuscha

AU - Willems, Stephan

AU - Beiert, Thomas

AU - Borlich, Martin

AU - Iden, Leon

AU - Füting, Anna

AU - Spittler, Raphael

AU - Gaspar, Thomas

AU - Richter, Sergio

AU - Schade, Anja

AU - Kuniss, Malte

AU - Neumann, Thomas

AU - Francke, Alexander

AU - Wunderlich, Carsten

AU - Shin, Dong In

AU - Meininghaus, Dirk Grosse

AU - Foresti, Mike

AU - Bonsels, Marc

AU - Reek, David

AU - Wiegand, Uwe

AU - Bauer, Alexander

AU - Metzner, Andreas

AU - Eckardt, Lars

AU - Popescu, Sorin Stefan

AU - Krahnefeld, Olaf

AU - Sticherling, Christian

AU - Kühne, Michael

AU - Nguyen, Dinh Quang

AU - Roten, Laurent

AU - Saguner, Ardan M.

AU - Linz, Dominik

AU - Van Der Voort, Pepijn

AU - Mulder, Bart A.

AU - Vijgen, Johan

AU - Almorad, Alexandre

AU - Guenancia, Charles

AU - Fauchier, Laurent

AU - Boveda, Serge

AU - Greef, Y. De

AU - Da Costa, Antoine

AU - Jais, Pierre

AU - Derval, Nicolas

AU - Milhem, Antoine

AU - Jesel, Laurence

AU - Garcia, Rodrigue

AU - Poty, Hervé

AU - Khoueiry, Ziad

AU - Seitz, Julien

AU - Laborderie, Julien

AU - Mechulan, Alexis

AU - Brigadeau, Francois

AU - Zhao, Alexandre

AU - Saludas, Yannick

AU - Piot, Olivier

AU - Ahluwalia, Nikhil

AU - Martin, Claire

AU - Chen, Jian

AU - Antolic, Bor

AU - Leventopoulos, Georgios

AU - Özcan, Emin Evren

AU - Yorgun, Hikmet

AU - Cay, Serkan

AU - Yalin, Kivanc

AU - Botros, Maichel Sobhy

AU - Mahmoud, Ahmed Taher

AU - Jȩdrzejczyk-Patej, Ewa

AU - Inaba, Osamu

AU - Okumura, Ken

AU - Ejima, Koichiro

AU - Khakpour, Houman

AU - Boyle, Noel

AU - Catanzaro, John N.

AU - Reddy, Vivek

AU - Mohanty, Sanghamitra

AU - Natale, Andrea

AU - Blessberger, Hermann

AU - Yang, Bing

AU - Stevens, Irene

AU - Sommer, Philipp

AU - Veltmann, Christian

AU - Steven, Daniel

AU - Vogler, Julia

AU - Kuck, Karl Heinz

AU - Merino, José Luis

AU - Keelani, Ahmad

AU - Heeger, Christian H.

PY - 2023/7/14

Y1 - 2023/7/14

N2 - Aims: Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse. Methods and results: This international multicentre registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553 729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed, at 214 centres in 35 countries. In 78 centres 138 patients [0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (P < 0.0001)] were diagnosed with an oesophageal fistula. Peri-procedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8% and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) [odds ratio 7.463 (2.414, 23.072) P < 0.001]. Conclusion: Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.

AB - Aims: Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse. Methods and results: This international multicentre registry investigates the characteristics of oesophageal fistulae after treatment of atrial fibrillation by catheter ablation. A total of 553 729 catheter ablation procedures (radiofrequency: 62.9%, cryoballoon: 36.2%, other modalities: 0.9%) were performed, at 214 centres in 35 countries. In 78 centres 138 patients [0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (P < 0.0001)] were diagnosed with an oesophageal fistula. Peri-procedural data were available for 118 patients (85.5%). Following catheter ablation, the median time to symptoms and the median time to diagnosis were 18 (7.75, 25; range: 0-60) days and 21 (15, 29.5; range: 2-63) days, respectively. The median time from symptom onset to oesophageal fistula diagnosis was 3 (1, 9; range: 0-42) days. The most common initial symptom was fever (59.3%). The diagnosis was established by chest computed tomography in 80.2% of patients. Oesophageal surgery was performed in 47.4% and direct endoscopic treatment in 19.8% and conservative treatment in 32.8% of patients. The overall mortality was 65.8%. Mortality following surgical (51.9%) or endoscopic treatment (56.5%) was significantly lower as compared to conservative management (89.5%) [odds ratio 7.463 (2.414, 23.072) P < 0.001]. Conclusion: Oesophageal fistula after catheter ablation of atrial fibrillation is rare and occurs mostly with the use of radiofrequency energy rather than cryoenergy. Mortality without surgical or endoscopic intervention is exceedingly high.

UR - http://www.scopus.com/inward/record.url?scp=85162056180&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehad250

DO - 10.1093/eurheartj/ehad250

M3 - Journal articles

C2 - 37062040

AN - SCOPUS:85162056180

SN - 0195-668X

VL - 44

SP - 2458

EP - 2469

JO - European Heart Journal

JF - European Heart Journal

IS - 27

ER -

A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: The POTTER-AF study

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