Kardiologia Polska
Clinical presentation, management, and outcomes among patients with oesophageal fistula after ablation of paroxysmal versus persistent atrial fibrillation: A POTTER-AF subanalysis
By Ewa Jędrzejczyk-Patej, Michał Mazurek, Radoslaw Lenarczyk and 22 others.
Abstract
Background
Esophageal fistula (EF) is a severe complication of atrial fibrillation (AF) ablation. Whether its clinical course varies by AF-type remains uncertain.
Aims
The aim of this study was to compare EF presentation, diagnosis, management, and outcomes among patients who developed EF after paroxysmal vs. persistent AF ablation.
Methods
This POTTER-AF registry subanalysis included patients with EF after AF or atrial tachycardia ablation.
Results
Among 553 729 ablation procedures, 138 EF cases were identified (0.025%); data were available for 118 patients: 69 with persistent AF and 49 with paroxysmal AF. AF-type-specific procedure denominators were unavailable, precluding assessment of subtype-specific incidence or relative risk. Patients with persistent AF had lower baseline left ventricular ejection fraction (55 [45–62]% vs. 60 [58–65]%; P <0.001), longer radiofrequency application (46 [29–60] vs. 29 [20–40] min; P = 0.02), and more frequent roof-line, posterior-line, and complex fractionated atrial electrograms ablation. No statistically significant differences were observed in EF presentation, diagnostic approach, or treatment strategy. Mortality was 47/68 (69.1%) vs. 30/49 (61.2%) (absolute difference, 7.9 percentage points; 95% confidence interval, −9.2 to 24.9; P = 0.37). AF type was not independently associated with mortality after adjustment for age and left ventricular ejection fraction.