Tilz, Roland Richard; Schmidt, Vanessa; Pürerfellner, Helmut; Maury, Philippe; Chun, Kr Julian; 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; ... (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), pp. 2458-2469. Oxford University Press 10.1093/eurheartj/ehad250
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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 multicenter 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 centers in 35 countries. In 78 centers 138 patients (0.025%, radiofrequency: 0.038%, cryoballoon: 0.0015% (p<0.0001)) were diagnosed with an oesophageal fistula. Periprocedural 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).
CONCLUSIONS
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.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery |
UniBE Contributor: |
Roten, Laurent |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1522-9645 |
Publisher: |
Oxford University Press |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
17 Apr 2023 10:03 |
Last Modified: |
15 Jul 2023 00:13 |
Publisher DOI: |
10.1093/eurheartj/ehad250 |
PubMed ID: |
37062040 |
Uncontrolled Keywords: |
Atrial fibrillation catheter ablation oesophageal fistula radiofrequency energy |
BORIS DOI: |
10.48350/181765 |
URI: |
https://boris.unibe.ch/id/eprint/181765 |
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