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

Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. Data on its incidence, management, and outcome are sparse. 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]. 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.

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

Déclaration de conflit d'intérêts

Conflict of interest R.R.T. is a consultant for Boston Scientific, Biotronik, and Biosense Webster and received speaker honoraria from Biosense Webster, Medtronic, Boston Scientific, and Abbot Medical. K.-H.K. reports grants and personal fees from Abbott Vascular, Medtronic, Biosense Webster, outside the submitted work. C.H.H. received travel grants and research grants from Boston Scientific, Lifetech, Biosense Webster, and Cardiofocus and speaker honoraria from Medtronic, Boston Scientific, Biosense Webster, Cardiofocus and C.T.I. GmbH and Doctrina Med. He is a consultant of Boston Scientific, Lifetech, Biosense Webster, and Cardiofocus. H.P.—receipt of honoraria or consultation fees: Bayer, Daiichi-Sankyo, Boehringer-Ingelheim, Pfizer, Abbott, Biosense-Webster, Boston Scientific, and Medtronic; participation in a company sponsored speaker’s bureau: Biosense Webster, Abbott, Medtronic, Boston. M.M.—consultant and speaker: Abbott Medical, Biosense Webster, Medtronic, and Boston Scientific. P.S.—advisory Board für Biosense Webster, Boston Scientific, Abbott, und Medtronic. C.S. received research support and lecture fees from Medtronic, Abbott, Boston Scientific, and Biosense Webster. In addition, C.S. is a consultant for Medtronic, Boston Scientific, and Biosense Webster. C.V.—honoraria for training and consulting: Biotronik, Medtronic EG Unrelated to the topic: consulting fees from Medtronic, Boston, Microport, Abbott MG Speaker‘s honoraria/travel grants: Abbott, Biosense Webster, Boston Scientific, Medtronic, and Farapulse Inc. S.W.—consulting fees, Abbott, Biosense Webster, Boston Scientific, Bristol Myers Squibb, Boehringer Ingelheim, Medtronic, and Daiichi. Grants: Abbott, Boston Scientific. M.B. has received consultant honoraria and/or lecture honoraria and/or and travel grants from: Bayer, Novartis, Biosense Webster, Biotronik, and Boston Scientific. The following applies to both authors: there are no conflicts of interest with regard to this publication. L.I. has received consultant honoraria and/or lecture honoraria and/or and travel grants from: Abbott Medical, Bayer, Berlin-Chemie, Biosense Webster, Biotronik, Bristol-Myers-Squibb, Daiichi-Sankyo, Medtronic, and Novartis. A.F.—educational grant from Boston Scientific. S.R.—consultant for Medtronic, Abbott, and Biotronik, Member of the Medtronic European Conduction System Pacing Advisory Board. M.K.—honoraria for teaching, proctoring and lectures, honoraria for advisory board activities, participation in clinical trials, travel grants. A.F.—lecture fees and Consultant für Biosense Webster. C.W.—lecture fees from Biosense Webster. U.W.—lecture fees from Abbott Medical und Medtronic Inc. A.M.—consultant fees: Medtronic, CardioFocus, Biosense-Webster, and Boston Scientific. Travel grants and lecture honoraria: Medtronic, Cardiofocus, Biosense-Webster, Boston Scientific, Lifetech, AstraZeneca, Boehringer Ingelheim, Bayer, and Philips-EPD. L.E.—discloses consultant fees, speaking honoraria, and travel expenses from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boehringer, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Pfizer, and Sanofi Aventis. Research has been supported by German Research Foundation (DFG) and German Heart Foundation outside the submitted work. C.S. reports grants and lecture fees from Biosense Webster and Medtronic and served as a proctor for Biosense Webster and Medtronic. He also reports grants from the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel, and the University of Basel. M.K. reports grants from the Swiss National Science Foundation (Grant numbers 33CS30_148474, 33CS30_177520, 32473B_176178, 32003B_197524), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel and the University of Basel, grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants from Biotronik, grants and personal fees from Daiichi Sankyo. L.R. has received speaker/consulting honoraria from Abbott/SJM and from Medtronic and has received a research grant for an investigator-initiated study to the institution from Medtronic. A.M.S. received educational grants through his institution from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, BMS/Pfizer, and Medtronic; and speaker/advisory board/consulting fees from Bayer Healthcare, Biotronik, Daiichi-Sankyo, Medtronic, Novartis, Pfizer and Stride Bio Inc. C.G.—research grants: MicroPort CRM. Consultant: MicroPort CRM, Boston Scientific, Abbott, Medtronic. Honoraria: Biotronik, Medtronic, Astra-Zeneca, BMS-Pfizer, Biosense-Webster. L.F. reports consulting fees for AstraZeneca, Bayer, BMS/Pfizer, Boehringer Ingelheim, Medtronic, Novo Nordisk, and Novartis and lecture fees for AstraZeneca, Bayer, BMS/Pfizer, Boehringer Ingelheim and Zoll. S.B.—consultant for Medtronic, Boston Scientific, Microport, and Zoll. N.L.—consulting fees for Abbott Medtronic and Boston Scientific PJ Grant from Biosense Webster, Metronic, ABBOTT, Boston. N.D. consultant for Biosense Webster. C.M. BSCI, Medtronic, Biosense Webster, Adagio—speaker honoraria and consultancy fees. P.H. BSCI and Medtronic—speaker honoraria. J.C. serves as a consultant for Biosense Webster, Johnson & Johnson. G.L.—In general, I have received funding from Biosense Webster, Medtronic, and Abbott (speaker honoraria). E.E.Ö.—payment from healthcare industry to my institution for my personal services: honoraria, consultancy, advisory board: Biosense Webster, Medtronic. H.Y.—proctor for Abbott, Medtronic, and Biosense Webster. S.C.—travel grants and speaker’s honoraria from Medtronic, Biosense Webster, and Abbott and is a proctor of Medtronic and Biotronik. E.J.—consultant fees from Biotronik, Medtronic, Abbott, Boston Scientific. K.O. received remuneration from Nippon Boehringer Ingelheim, Daiichi Sankyo, Johnson & Johnson, and Medtronic. J.N.C. Circa Scientific: research support. V.Y.R. does not report any disclosures directly related to this manuscript; but unrelated to this manuscript, he has served as a consultant for and has equity in Ablacon, Acutus Medical, Affera-Medtronic, Anumana, Apama Medical-Boston Scientific, APN Health, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, CardioNXT/AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EPD-Philips, EP Frontiers, Epix Therapeutics-Medtronic, EpiEP, Eximo, Farapulse-Boston Scientific, Field Medical, Focused Therapeutics, HRT, Intershunt, Javelin, Kardium, Keystone Heart, LuxMed, Medlumics, Middlepeak, Neutrace, Nuvera-Biosense Webster, Oracle Health, Restore Medical, Sirona Medical, SoundCath, Valcare; unrelated to this work, has served as a consultant for Abbott, AtriAN, Biosense-Webster, BioTel Heart, Biotronik, Boston Scientific, Cairdac, Cardiofocus, Cardionomic, CoreMap, Fire1, Gore & Associates, Impulse Dynamics, Medtronic, Novartis, Philips, Pulse Biosciences; and has equity in Manual Surgical Sciences, Newpace, Nyra Medical, Surecor, and Vizaramed’. A.N. consultant for Abbott, Baylis, biosense webster, biotronik, boston scientific and Medtronic DS research grant: Abbott, Medtronic, Johnson&Johnson; advisory board: Pfizer, Abbott; speaker fee: Abbott, Medtronic, Johnson&Johnson. J.L.M. received speaker fees and/or honoraria for lectures and scientific advice from Biotronik, Medtronic, Microport, Milestone Pharmaceutical, Sanofi, and Zoll. K.H.K. reports grants and personal fees from Abbott Vascular, Medtronic, Biosense Webster outside submitted work. All other authors have no relevant disclosures.