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September 3, 2026European Heart Journal OpenOpen Access

Women undergo more endoscopic and fewer surgical post-AF ablation fistula repairs, with similar fatality to men.

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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?

Population

117 patients with oesophageal fistula following AF ablation across 214 centres in 35 countries

Comparison

Female vs male patients

Design

Global multicentre observational study subanalysis

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).

Authors

SPS S PopescuATAnna TraubVSV Schmidt

Discussion

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Overview

High fatality rates exceed 60% without sex differences in post-ablation esophageal fistula; observational data leaves open whether management variations affect survival.

Key Points

  • To assess sex-based variations in clinical presentation, procedural management, and mortality among patients developing esophageal fistula after atrial fibrillation ablation.
  • Subanalysis of the international, multicenter POTTER-AF registry covering 553,729 catheter ablation procedures across 214 centers in 35 countries between 1996 and 2022.
  • Evaluated sex-specific management patterns and clinical outcomes in 117 patients confirmed to have esophageal fistula.
  • Fewer women received post-procedural proton pump inhibitors (64.8% vs. 84.7%; p=0.017) and fewer developed atrio-oesophageal fistula (90.9% vs. 100%; p=0.021), while isolated esophageal perforation occurred only in females.
  • Management pathways differed significantly: women underwent endoscopic therapy more often (35.8% vs. 17.7%; p=0.034) and surgery alone less frequently (28.3% vs. 51.6%; p=0.014).
  • Overall fatality rates were extremely elevated and showed no significant difference between females and males (63.6% vs. 67.2%; p=0.70).

Study Design

Type

Observational (n=117)

Multicenter

Yes

Structured PICO

Are there sex-based differences in the management and outcomes of oesophageal fistula following atrial fibrillation ablation?

P
Population
117 patients (47% female) who developed an oesophageal fistula following atrial fibrillation ablation, analyzed for sex-based differences in management and outcomes.
E
Exposure
Female sex
C
Comparator
Male sex
O
Outcome
Fatality rates and management strategies (endoscopic vs. surgical treatment)hard clinical

Main Result

Absolute Event Rate: 63.6% vs 67.2%

p-value: p=0.70

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.

Limitations

  • OF incidence for each sex could not be calculated

Cite This Study

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).

synapsesocial.com/papers/6a993576636c6408cfa7d9fdhttps://doi.org/10.1093/ehjopen/oeag134
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Impact of gender on the management and prognosis of oesophageal fistula after atrial fibrillation ablation - a subanalysis of the worldwide POTTER-AF study2024 · 1 citations
  2. 2Impact of age on the management and prognosis of oesophageal fistula after atrial fibrillation ablation - a subanalysis of the worldwide POTTER-AF study2024
  3. 3Endoscopic versus surgical treatment for the management of oesophageal fistula after atrial fibrillation ablation - a subanalysis of the worldwide POTTER-AF study2024
  4. 4Sex‐based differences in safety and efficacy of catheter ablation for atrial fibrillation2023 · 23 citations
  5. 5Sex- Based Differences in Safety and Efficacy of Catheter Ablation for Atrial Fibrillation2023 · 2 citations