Roland R. Tilz, MD
The POTTER-AF study revealed that a surgical or endoscopic intervention is necessary to reduce the risk for death in patients with esophageal fistula (EF) following catheter ablation for atrial fibrillation (AF). With conservative treatment only, the mortality rate is approximately 90%.
“EFs are a rare, but devastating, complication of AF,” said Roland R. Tilz, MD, who delivered his remarks at the 2023 European Heart Rhythm Association (EHRA) in Barcelona, Spain1,2. However, he added that “current data on the incidence, management, and outcomes of EF is sparse.” The POTTER-AF study, he explained, aimed to investigate EF in patients with AF who underwent catheter ablation.
In total, 214 centers in 35 countries performed 553,729 procedures; 138 cases of EF were detected, resulting in an incidence of 0.025% in the study population. Furthermore, compared with those receiving cryoballoon ablation, the risk for EF was higher in those undergoing radiofrequency ablation (0.038% vs 0.0015%; P<0.001). The median time to symptom onset was 18 days and the median time to diagnose EF was 21 days, Dr. Tilz noted. Chest pain, fever, neurological symptoms, and odynophagia were the most common symptoms. The most common delayed complication was severe sepsis, occurring in more than 50% of patients with EF. Approximately 25% of patients suffered from a cerebrovascular event and one out of five patients experienced cardiac arrest.
“The outcomes for EF are abysmal, with a mortality rate of 65.8%,” Dr. Tilz said. “Only 15.4% of the patients survive without sequela.” The death rate is much higher in patients who were treated conservatively (90%) than in those who underwent endoscopic treatment (56%) or surgical treatment (52%). The use of an esophageal temperature probe and the type of anesthesia (conscious sedation) were linked with better survival outcomes, he added.
“Thus, surgical or endoscopic intervention is mandatory to improve the survival outcomes in patients with EF,” concluded Dr. Tilz.
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