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 languageEnglish
JournalEuropean Heart Journal
Volume44
Issue number27
Pages (from-to)2458-2469
Number of pages12
ISSN0195-668X
DOIs
Publication statusPublished - 14.07.2023

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

Cite this