Sex-Based Differences in the Management and Outcomes of Oesophageal Fistula Following Atrial Fibrillation Ablation: A Subanalysis of the Worldwide POTTER-AF Study
Year: 2026
Type: article
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.
Source: European Heart Journal Open
Authors: Sorin Stefan Popescu, Anna Traub, Vanessa 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 Guenancia, Laurent Fauchier, Serge Boveda, Yves De Greef, Antoine Da Costa, Pierre Jais, 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 Cay, Kivanc Yalin, Maichel Sobhy Botros, Ewa Jędrzejczyk-Patej, Osamu Inaba, Ken Okumura, Koichiro Ejima, Houman Khakpour, John N Catanzaro, Vivek Reddy, Andrea Natale, Hermann Blessberger, Bing Yang, Julia Vogler, Claudia Schmidtke, Ardan M Saguner, Karl-Heinz Kuck, José Luis Merino, Ahmad Keelani, Christian-H Heeger, Roland Richard Tilz
Institutions: University Hospital Schleswig-Holstein, German Centre for Cardiovascular Research, University of Lübeck, University of Cologne, University Hospital Cologne, Krankenhaus der Elisabethinen, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Agaplesion Markus Hospital, Hôpital Rangueil, Sorbonne Université, Pitié-Salpêtrière Hospital, Asklepios Klinik St. Georg, Asklepios Kliniken Hamburg, University Hospital Bonn, Segeberger Kliniken, Witten/Herdecke University, Alfried Krupp Hospital, University Medical Center of the Johannes Gutenberg University Mainz, Herzzentrum Dresden Universitätsklinik, Technische Universität Dresden, Rhön-Klinikum, Helios Klinikum Erfurt, Kerckhoff Klinik, Helios Kliniken, Helios Klinikum Krefeld, Medizinische Universität Lausitz - Carl Thiem, Kliniken Maria Hilf, University Hospital Augsburg, Sana Kliniken AG, University Medical Center Hamburg-Eppendorf, University Hospital Münster, University Hospital of Basel, University of Bern, University Hospital of Bern, Maastricht University Medical Centre, Maastricht University, Catharina Ziekenhuis, University Medical Center Groningen, University of Groningen, Jessa Hospital, Hartcentrum Hasselt, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, CHU Dijon Bourgogne, Centre Hospitalier Universitaire de Tours, Clinique Pasteur, Ziekenhuisnetwerk Antwerpen Stuivenberg, Université Jean Monnet, Centre Hospitalier Universitaire de Bordeaux, Electrophysiology and Heart Modeling Institute, Centre Hospitalier de La Rochelle, Hôpitaux Universitaires de Strasbourg, Université de Poitiers, Centre Hospitalier Universitaire de Poitiers, Hôpital Saint Joseph, Centre Hospitalier de la Côte Basque, Hôpital privé Clairval, Centre Hospitalier Universitaire de Lille, Clinique Ambroise Paré, Centre Cardiologique du Nord, Queen Mary University of London, Barts Health NHS Trust, Royal Papworth Hospital, Haukeland University Hospital, University of Bergen, Ljubljana University Medical Centre, University of Patras, Dokuz Eylül University, Hacettepe University, Sağlık Bilimleri Üniversitesi, Istanbul University-Cerrahpaşa, Istanbul University, Cairo University, Silesian Center for Heart Disease, Saitama Red Cross Hospital, Saiseikai Kumamoto Hospital, Tokyo Women's Medical University, University of California, Los Angeles, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, John T. Mather Memorial Hospital, Icahn School of Medicine at Mount Sinai, University of Rome Tor Vergata, St David's Medical Center, Texas Cardiac Arrhythmia, MetroHealth Medical Center, Case Western Reserve University, Johannes Kepler University of Linz, Kepler Universitätsklinikum, Tongji University, Shanghai East Hospital, University Hospital Zurich, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Zentralklinik Bad Berka, Asklepios Klinik Altona, Asklepios
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,673
OpenAlex ID: W7204903467
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