Key result
Female sex was associated with more frequent endoscopic and less frequent surgical interventions for oesophageal fistula after AF ablation, with similar fatality rates to men (63.6% vs 67.2%; p=0.70).
Why the study?
Oesophageal fistula is a rare, life-threatening complication of AF ablation, but data on sex-related differences in its management and outcomes are limited.
Are there sex-based differences in the management and outcomes of oesophageal fistula following atrial fibrillation ablation?
Observational (n=117)
Yes
Are there sex-based differences in the management and outcomes of oesophageal fistula following atrial fibrillation ablation?
While women with oesophageal fistula post-AF ablation undergo endoscopic therapy more often and surgery less often than men, the extremely high fatality rates are comparable between sexes.
Answers are grounded in this paper and cite their sources.
High fatality rates exceed 60% without sex differences in post-ablation esophageal fistula; observational data leaves open whether management variations affect survival.
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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Popescu et al. (2026) conducted an observational in Oesophageal fistula following atrial fibrillation ablation (n=117). Female sex vs. Male sex was evaluated on Fatality rate (p=0.70). Female sex was associated with more frequent endoscopic and less frequent surgical interventions for oesophageal fistula after AF ablation, with similar fatality rates to men (63.6% vs 67.2%; p=0.70).
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