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

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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Journal
European Heart Journal Open
Published
2026-09-01
DOI
https://doi.org/10.1093/ehjopen/oeag134
Primary Topic
Atrial Fibrillation Management and Outcomes
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article
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article

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

Roland Richard Tilz, Helmut Pürerfellner, Anja Schade, Lars Eckardt et al.
European Heart Journal Open
Atrial Fibrillation Management and Outcomes
article

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

Roland Richard Tilz, Helmut Pürerfellner, Anja Schade, Lars Eckardt, Christian Sohns, Laurent Roten, Sanghamitra Mohanty, Nikhil Ahluwalia, Ken Okumura, Charles Guénancia, Yannick Saludas, Malte Kuniss, Vivek Reddy, David Reek, John N. Catanzaro, Bing Yang, Estelle Gandjbakhch, Leon Iden, Kıvanç Yalın, Hikmet Yorgun, Alexis Mechulan, Olaf Krahnefeld, Sergio Richter, Johan M. Vijgen, Koichiro Ejima, Christian Veltmann, Raphael Spittler, Houman Khakpour, Alexandre Zhao, Mike Foresti, Olivier Piot, V Schmidt, Serge Bovéda, Hermann Blessberger, Dirk Große Meininghaus, Thomas Beiert, Julia Vogler, Antoine Milhem, Philipp Sommer, Julien Seitz, Michael Kühne, Pierre Jaı̈s, Andreas Metzner, Julien Laborderie, Carsten Wunderlich, Yves De Greef, Pepijn van der Voort, Dong‐In Shin, Serkan Çay, Stephan Willems, Bart A. Mulder, Christian Sticherling, S S Popescu, Ewa Jędrzejczyk‐Patej, Philippe Maury, José Luís Merino, Alexandre Almorad, Antoine Da Costa, Maichel Botros, Ziad Khoueiry, Anna Füting, Bruno Degand, Jian Chen, K. Ahmad, Laurence Jesel, Dinh Quang Nguyen, Claudia Schmidtke, Uwe Wiegand, Christian-H Heeger, Anna Traub, Hervé Poty, Francois Brigadeau, Daniel Steven, Osamu Inaba, Alexander Bauer, Laurent Fauchier, Dominik Linz, Reşit Yiğit Yilancioğlu, Ardan M Saguner, Bor Antolic, K R Julian Chun, Claire A Martin, Karl-Heinz Kuck, Georgios Leventopoulos
article en

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.

European Heart Journal Open
Rhön-Klinikum (DE), University of Rome Tor Vergata (IT), University of Bern (CH), University Medical Center Groningen (NL), Vrije Universiteit Brussel (BE), Cairo University (EG), Radboud University Nijmegen (NL), Université de Bordeaux (FR), Witten/Herdecke University (DE), Universität Hamburg (DE), Queen Mary University of London (GB), University of Patras (GR), University of Cologne (DE), Dokuz Eylül University (TR), Johannes Gutenberg University Mainz (DE), Barts Health NHS Trust (GB), Université de Lille (FR), University Hospital Bonn (DE), Royal Papworth Hospital (GB), UCLA Health (US), Heart and Diabetes Center North Rhine-Westphalia (DE), Hospital Universitario La Paz (ES), Haukeland University Hospital (NO), University Hospital of Bern (CH), Catharina Ziekenhuis (NL), Ljubljana University Medical Centre (SI), University Hospital Augsburg (DE), University Hospital of Basel (CH), University Medical Center (US), Université de Poitiers (FR), Maastricht University (NL), Sorbonne Université (FR), Electrophysiology and Heart Modeling Institute (FR), Asklepios Klinik Altona (DE), Lille’s Cardiology Hospital (FR), Clinique Saint Pierre (BE), München Klinik Schwabing (DE), Hospital Base (CL), Centre Hospitalier Universitaire de Tours (FR), Jessa Hospital (BE), Saiseikai Kumamoto Hospital (JP), University Hospital of Zurich (CH), Mount Sinai Hospital (US), Helios Klinikum Krefeld (DE), Sana Kliniken AG (DE), Hospital La Paz Institute for Health Research (ES), University Hospital Münster (DE), Donald & Barbara Zucker School of Medicine at Hofstra/Northwell (US), Zentralklinik Bad Berka (DE), Hôpital privé Clairval (FR), Kliniken Maria Hilf (DE), University Medical Center Hamburg-Eppendorf (DE), Centre Hospitalier Universitaire de Poitiers (FR), Istanbul University-Cerrahpaşa (TR), University Hospital Schleswig-Holstein (DE), Hôpital Saint Joseph (FR), Kepler Universitätsklinikum (AT), John T. Mather Memorial Hospital (US), Pitié-Salpêtrière Hospital (FR), Asklepios Klinik St. Georg (DE), Hôpital Rangueil (FR), Universitair Ziekenhuis Brussel (BE), Centre Hospitalier de la Côte Basque (FR), German Centre for Cardiovascular Research (DE), Shanghai East Hospital (CN), Sağlık Bilimleri Üniversitesi (TR), Centre Hospitalier Universitaire de Clermont-Ferrand (FR), Krankenhaus der Elisabethinen (AT), Silesian Center for Heart Disease (PL), Kerckhoff Klinik (DE), Tokyo Women's Medical University (JP), Délégation Provence et Corse (FR), Yüksek İhtisas Üniversitesi (TR), Helios Kliniken (DE), Clinique Pasteur (FR), LVR-Klinik Köln (DE), Centre Hospitalier de La Rochelle (FR), Maison des Sciences sociales et des Humanités de Dijon (FR), Medizinische Universität Lausitz - Carl Thiem (DE), Texas Cardiac Arrhythmia (US), Agaplesion Markus Hospital (DE), Helios Klinikum Erfurt (DE), Saitama Red Cross Hospital (JP), Segeberger Kliniken (DE), Ziekenhuisnetwerk Antwerpen Stuivenberg (BE), Alfried Krupp Hospital (DE), University Hospital Cologne (DE), Centre Cardiologique du Nord (FR), Clinique Ambroise Paré (FR), MetroHealth Medical Center (US), Clinique du Grand Large (FR), Universidad Autónoma de Madrid (ES), Hacettepe University (TR), Université de Strasbourg (FR), Technische Universität Dresden (DE), Université Jean Monnet (FR), University of Lübeck (DE)
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