Sex-Based Differences in the Management and Outcomes of Oesophageal Fistula Following Atrial Fibrillation Ablation: A Subanalysis of the Worldwide POTTER-AF Study

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ID: 327019
2026
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Abstract
Abstract Background and aims Oesophageal fistula (OF) is a rare but life-threatening complication of atrial fibrillation (AF) ablation. Data on sex-related differences in its management and outcomes are limited. Methods The POTTER-AF study is a global, multicentre study evaluating the incidence, management, and outcome of OF following AF ablation. Among 553,729 patients treated across 214 centres in 35 countries between 1996-2022, 138 developed OF. Sex-specific data on management and outcome were available in 117 cases and are analysed herein. Results Females comprised 47% of the analysed cohort. Baseline characteristics, ablation modality, and use of oesophageal temperature monitoring were not different between sexes in patients developing OF. Fewer women received proton pump inhibitors post-procedure (64.8% vs. 84.7%; p=0.017). Among patients with OF, less women developed atrio-oesophageal fistula (90.9% vs. 100%; p=0.021). Oesophageal perforation and oesophageal-pericardial fistula occurred exclusively in females. The median duration until symptoms onset was 20 days for women and 16.5 days for men (p=0.14). Echocardiography was more frequently used in women (36.4% vs. 15%; p=0.01). Stroke was more common in women (32.7% vs. 14.8%; p=0.040), however only before adjusting for potential cofounders. Other complications were comparable. Women underwent endoscopic therapy more often (35.8% vs. 17.7%; p=0.034) and surgical treatment alone less frequently (28.3% vs. 51.6%; p=0.014). Fatality rates were high and not different (63.6% in women vs. 67.2% in men; p=0.70) . Conclusion While OF incidence for each sex could not be calculated, nearly half of all patients with OF were female. Women underwent more often endoscopic and less often surgical interventions; outcomes were comparable.
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Authors S S Popescu, Anna Traub, V Schmidt, Helmut Pürerfellner, Philipp Sommer, Christian Sohns, Christian Veltmann, Daniel Steven, K R Julian Chun, Philippe Maury, Estelle Gandjbakhch, Stephan Willems, Thomas Beiert, Leon Iden, Anna Füting, Raphael Spittler, Sergio Richter, Anja Schade, Malte Kuniss, Carsten Wunderlich, Dong‐In Shin, Dirk Große Meininghaus, Mike Foresti, David Reek, Uwe Wiegand, Alexander Bauer, Andreas Metzner, Lars Eckardt, Olaf Krahnefeld, Christian Sticherling, Michael Kühne, Dinh Quang Nguyen, Laurent Roten, 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, Antoine Milhem, Laurence Jesel, Bruno Degand, Hervé Poty, Ziad Khoueiry, Julien Seitz, Julien Laborderie, Alexis Mechulan, Francois Brigadeau, Alexandre Zhao, Yannick Saludas, Olivier Piot, Nikhil Ahluwalia, Claire A Martin, Jian Chen, Bor Antolic, Georgios Leventopoulos, Reşit Yiğit Yilancioğlu, Hikmet Yorgun, Serkan Çay, Kıvanç Yalın, Maichel Botros, Ewa Jędrzejczyk‐Patej, Osamu Inaba, Ken Okumura, Koichiro Ejima, Houman Khakpour, John N. Catanzaro, Vivek Reddy, Sanghamitra Mohanty, Hermann Blessberger, Bing Yang, Julia Vogler, Claudia Schmidtke, Ardan M Saguner, Karl-Heinz Kuck, José Luís Merino, K. Ahmad, Christian-H Heeger, Roland Richard Tilz
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Journal European Heart Journal Open
Year 2026
DOI
10.1093/ehjopen/oeag134
URL
https://doi.org/10.1093/ehjopen/oeag134
Keywords Keywords not found

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