Arrhythmias & electrophysiologyCohort study
A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study
- International multicentre registry (survey)
Authors' 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.
Study context
- Population
- Patients with oesophageal fistula after AF catheter ablationof 553,729 procedures, 214 centres
- Participants
- 138 patients
- Outcome
- Incidence, management and outcome of oesophageal fistula after AF catheter ablation
Main finding
As reported in the abstract
Oesophageal fistula incidence
Overall incidence (138 patients)
0.025%
Radiofrequency incidence
0.038%
Cryoballoon incidence
0.0015%
Radiofrequency vs cryoballoon
P < 0.0001
Observational data: associations, not effects.
Further findings
| Outcome | Surgical | Endoscopic | Conservative | OR (CI) | P value | |
|---|---|---|---|---|---|---|
| Mortality by management | 51.9% | 56.5% | 89.5% | 7.463 (2.414–23.072) | P < 0.001 | |
| 0.050.21520Odds ratio (log scale) |
- Mortality by management — Overall mortality
- 65.8%
Time course after ablation
- Median time to symptoms (days)
- 18 (7.75, 25; range: 0-60)
- Median time to diagnosis (days)
- 21 (15, 29.5; range: 2-63)
- Median symptom onset to diagnosis (days)
- 3 (1, 9; range: 0-42)
- Fever as most common initial symptom
- 59.3%
- Diagnosis by chest CT
- 80.2%
- peri-procedural data available for 118 patients (85.5%)
Management
- Oesophageal surgery
- 47.4%
- Direct endoscopic treatment
- 19.8%
- Conservative treatment
- 32.8%
Original publication
A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study. Eur Heart J. Published 16 April 2023. doi:10.1093/eurheartj/ehad250
Summarised from the published abstract; every number is checked against it