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Title: | 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 Puererfellner, Helmut Maury, Philippe Chun, K. R. Julian Martinek, Martin Sohns, Christian Schmidt, Boris Mandel, Franck Gandjbakhch, Estelle Laredo, Mikael Gunawardene, Melanie Anuscha Willems , Stephan Beiert, Thomas Borlich, Martin Iden, Leon Fueting, 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 Tefan Krahnefeld, Olaf Sticherling, Christian Kuehne, Michael Dinh Quang Nguyen Roten, Laurent Saguner, Ardan M. Linz, Dominik van der Voort, Pepijn Mulder, Bart A. VIJGEN, Johan Almorad, Alexandre Guenancia, Charles Fauchier, Laurent Boveda, Serge De Greef, Y. Da Costa, Antoine Jais, Pierre Derval, Nicolas Milhem, Antoine Jesel, Laurence Garcia, Rodrigue Poty, Herve 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 Ozcan, Emin Evren Yorgun, Hikmet Cay, Serkan Yalin, Kivanc Botros, Maichel Sobhy Mahmoud, Ahmed Taher Jedrzejczyk-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, Jose Luis Keelani, Ahmad Heeger, Christian-H. |
Issue Date: | 2023 | Publisher: | OXFORD UNIV PRESS | Source: | EUROPEAN HEART JOURNAL, 44 (27) , p. 2458 -2469 | 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. | Notes: | Tilz, RR; Heeger, CH (corresponding author), Univ Hosp Schleswig Holstein, Univ Heart Ctr Lubeck, Dept Rhythmol, Ratzeburger Allee 160, D-23538 Lubeck, Germany.; Tilz, RR; Heeger, CH (corresponding author), German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Lubeck, Lubeck, Germany. tilz6@hotmail.com; christian.heeger@gmx.net |
Keywords: | Atrial fibrillation;Catheter ablation;Radiofrequency energy;Oesophageal fistula | Document URI: | http://hdl.handle.net/1942/40697 | ISSN: | 0195-668X | e-ISSN: | 1522-9645 | DOI: | 10.1093/eurheartj/ehad250 | ISI #: | 000992617700001 | Rights: | The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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