The Lead Episode 6: A Discussion of the POTTER-AF Study-European Heart Journal

European Heart Journal

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The study titled POTTER-AF examined the occurrence, treatment, and prognosis of oesophageal fistula formation following catheter ablation for atrial fibrillation. Data from 214 centers in 35 countries and 553,729 procedures were analyzed. Out of these, 138 patients (0.025%) were diagnosed with an oesophageal fistula. Radiofrequency energy use was found to have a higher incidence of oesophageal fistula compared to cryoballoon energy. On average, symptoms appeared 18 days after the ablation, and diagnosis occurred 21 days after. The initial symptom was typically fever. Approximately half the patients underwent oesophageal surgery, while one-fifth received direct endoscopic treatment, and one-third were managed conservatively. The mortality rate was 65.8%, but surgical or endoscopic intervention led to better survival rates compared to conservative management. The study concludes that although oesophageal fistula after catheter ablation for atrial fibrillation is rare, it can lead to high mortality if not treated with surgical or endoscopic methods. Early detection and appropriate management are crucial for improving outcomes.<br /><br />Another survey was conducted across various centers globally to explore the occurrence, treatment, and prognosis of atrioesophageal fistula (OF) after catheter ablation for atrial fibrillation. The study included 118 patients. The incidence of OF was very low, with an overall rate of 0.025%. RF ablation had a significantly higher incidence (0.038%) compared to cryoballoon ablation (0.0015%). OF symptoms and diagnosis were generally delayed after the ablation, and the time from symptom onset to OF diagnosis was three days on average. Fever was the most common initial symptom, followed by chest pain/odynophagia and neurological signs. The primary diagnostic method used was chest CT. The prognosis for patients with OF was generally poor, with a mortality rate of 65.8%. Surgical or endoscopic intervention had better survival rates than conservative management. The use of an oesophageal temperature probe and conscious sedation during the procedure were also associated with improved survival. The study emphasizes the importance of early detection, management, and treatment of OF to enhance patient outcomes. Further research and collaborative efforts are necessary to better understand the risk factors and optimize treatment strategies for OF following catheter ablation for atrial fibrillation.

Keywords

POTTER-AF

oesophageal fistula

catheter ablation

atrial fibrillation

radiofrequency energy

cryoballoon energy

symptoms

diagnosis

surgical intervention

endoscopic treatment