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

Tilz, RR; Schmidt, V; Pürerfellner, H; Maury, P; Chun, KRJU; 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, SȘ; 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, Y; 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; Jędrzejczyk-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

doi:10.1093/eurheartj/ehad250

Arrhythmias & electrophysiology

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

Eur Heart JPublished 16 Apr 2023International multicentre registry

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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

Methodological detailssurvey

Survey

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	← Lower odds with conservative ←→ Higher odds with conservative →	OR (CI)	P value
Mortality by managementConservativevs Surgical or endoscopic	51.9%	56.5%	89.5%	0.050.21520	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%

Reference

Authors: Tilz RR, Schmidt V, Pürerfellner H, Maury P, Chun KRJU, Martinek M, et al.
All 97 authors
Tilz RR, Schmidt V, Pürerfellner H, Maury P, Chun KRJU, 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 SȘ, 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 Y, 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, Jędrzejczyk-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
Journal: European Heart Journal
Published: 16 Apr 2023
DOI: 10.1093/eurheartj/ehad250
PubMed: 37062040

Topic: Arrhythmias & electrophysiology

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

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