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, Mikaël Laredo, Melanie Gunawardene, Stephan Willems, Thomas Beiert, Martin Borlich, Leon Iden, Anna Füting, Raphael Spittler, Thomas Gaspar, Sergio Richter, Anja Schade, Malte Kuniss, Thomas Neumann, Alexander Francke, Carsten Wunderlich, Dong‐In Shin, Dirk Große Meininghaus, Mike Foresti, Marc Bonsels, David Reek, Uwe Wiegand, Alexander T. Bauer, Andreas Metzner, Lars Eckardt, S S 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 Guénancia, Laurent Fauchier, Serge Bovéda, Yves De Greef, Antoine Da Costa, Pierre Jaı̈s, Nicolas Derval, Antoine Milhem, Laurence Jesel, Rodrigue Garcia, Hervé Poty, Ziad Khoueiry, Julien Seitz, Julien Laborderie, Alexis Mechulan, François Brigadeau, Alexandre Zhao, Yannick Saludas, Olivier Piot, Nikhil Ahluwalia, Claire Martin, Jian Chen, Bor Antolič, Georgios Leventopoulos, Emin Evren Özcan, Hikmet Yorgun, Serkan Çay, Kıvanç Yalın, Maichel Botros, Ahmed Taher Mahmoud, Ewa Jędrzejczyk‐Patej, Osamu Inaba, Ken Okumura, Koichiro Ejima, Houman Khakpour, Noel Boyle, John N. Catanzaro, Vivek Y. Reddy, Sanghamitra Mohanty, Andrea Natale, Hermann Blessberger, Bing Yang, Irene Stevens, Philipp Sommer, Christian Veltmann, Daniel Steven, Julia Vogler, Karl‐Heinz Kück, José Luís Merino, Ahmad Keelani, Christian‐Hendrik Heeger
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.