Sex-based differences in the management and outcomes of oesophageal fistula following atrial fibrillation ablation: a subanalysis of the worldwide POTTER-AF study
European Heart Journal Open, cilt.6, sa.5, 2026 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 6 Sayı: 5
- Basım Tarihi: 2026
- Doi Numarası: 10.1093/ehjopen/oeag134
- Dergi Adı: European Heart Journal Open
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, BIOSIS, Directory of Open Access Journals, Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: Atrial fibrillation, Catheter ablation, Oesophageal fistula, Sex-based differences
- Dokuz Eylül Üniversitesi Adresli: Evet
Özet
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 and results: The PrOgnosis following oesophageal fisTula formaTion in patients undergoing cathetER ablation for 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 and 2022, 138 developed OF. Sex-specific data on management and outcome were available in 117 cases and are analysed herein. 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-OF (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.