A worldwide survey on incidence, management, and prognosis of oesophageal fistula formation following atrial fibrillation catheter ablation: the POTTER-AF study
Authors: Tilz Roland Richard , Schmidt Vanessa , Pürerfellner Helmut , Maury Philippe , Chun K R J ulian , Martinek Martin , Sohns Christian , Schmidt Boris , Mandel Franck , Gandjbakhch Estelle , Laredo Mikael , Gunawardene Melanie Anuscha , Willems Stephan , Beiert Thomas , Borlich Martin , Iden Leon , Füting Anna , Spittler Raphael , Gaspar Thomas , Richter Sergio , Schade Anja , Kuniss Malte , Neumann Thomas , Francke Alexander , Wunderlich Carsten , Shin Dong-In , Meininghaus Dirk Grosse , Foresti Mike , Bonsels Marc , Reek David , Wiegand Uwe , Bauer Alexander , Metzner Andreas , Eckardt Lars , Popescu Sorin Ștefan , Krahnefeld Olaf , Sticherling Christian , Kühne Michael , Nguyen Dinh Quang , Roten Laurent , Saguner Ardan M , Linz Dominik , van der Voort Pepijn , Mulder Bart A , Vijgen Johan , Almorad Alexandre , Guenancia Charles , Fauchier Laurent , Boveda Serge , Greef Y De , Da Costa Antoine , Jais Pierre , Derval Nicolas , Milhem Antoine , Jesel Laurence , Garcia Rodrigue , Poty Hervé , Khoueiry Ziad , Seitz Julien , Laborderie Julien , Mechulan Alexis , Brigadeau Francois , Zhao Alexandre , Saludas Yannick , Piot Olivier , Ahluwalia Nikhil , Martin Claire , Chen Jian , Antolic Bor , Leventopoulos Georgios , Özcan Emin Evren , Yorgun Hikmet , Cay Serkan , Yalin Kivanc , Botros Maichel Sobhy , Mahmoud Ahmed Taher , Jędrzejczyk-Patej Ewa , Inaba Osamu , Okumura Ken , Ejima Koichiro , Khakpour Houman , Boyle Noel , Catanzaro John N , Reddy Vivek , Mohanty Sanghamitra , Natale Andrea , Blessberger Hermann , Yang Bing , Stevens Irene , Sommer Philipp , Veltmann Christian , Steven Daniel , Vogler Julia , Kuck Karl-Heinz , Merino José Luis , Keelani Ahmad , Heeger Christian-H 
Published: April 2023

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 &lt; 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 &lt; 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.