Sex-based differences in the management and outcomes of oesophageal fistula following atrial fibrillation ablation: a subanalysis of the worldwide POTTER-AF study
Abstract
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.
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BibTeX
@article{popescu2026sexbased,
title = {{Sex-based differences in the management and outcomes of oesophageal fistula following atrial fibrillation ablation: a subanalysis of the worldwide POTTER-AF study}},
author = {Sorin Stefan Popescu and Anna Traub and Vanessa Schmidt and Helmut Pürerfellner and Philipp Sommer and Christian Sohns and Christian Veltmann and Daniel Steven and K R Julian Chun and Philippe Maury and Estelle Gandjbakhch and Stephan Willems and Thomas Beiert and Leon Iden and Anna Füting and Raphael Spittler and Sergio Richter and Anja Schade and Malte Kuniss and Carsten Wunderlich and Dong-In Shin and Dirk Grosse Meininghaus and Mike Foresti and David Reek and Uwe Wiegand and Alexander Bauer and Andreas Metzner and Lars Eckardt and Olaf Krahnefeld and Christian Sticherling and Michael Kühne and Dinh Quang Nguyen and Laurent Roten and Dominik Linz and Pepijn van der Voort and Bart A Mulder and Johan Vijgen and Alexandre Almorad and Charles Guenancia and Laurent Fauchier and Serge Boveda and Yves De Greef and Antoine Da Costa and Pierre Jais and Antoine Milhem and Laurence Jesel and Bruno Degand and Hervé Poty and Ziad Khoueiry and Julien Seitz and Julien Laborderie and Alexis Mechulan and Francois Brigadeau and Alexandre Zhao and Yannick Saludas and Olivier Piot and Nikhil Ahluwalia and Claire A Martin and Jian Chen and Bor Antolic},
journal = {European Heart Journal Open},
year = {2026},
month = sep,
doi = {10.1093/ehjopen/oeag134},
url = {https://doi.org/10.1093/ehjopen/oeag134},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Sex-based differences in the management and outcomes of oesophageal fistula following atrial fibrillation ablation: a subanalysis of the worldwide POTTER-AF study
AU - Sorin Stefan Popescu
AU - Anna Traub
AU - Vanessa Schmidt
AU - Helmut Pürerfellner
AU - Philipp Sommer
AU - Christian Sohns
AU - Christian Veltmann
AU - Daniel Steven
AU - K R Julian Chun
AU - Philippe Maury
AU - Estelle Gandjbakhch
AU - Stephan Willems
AU - Thomas Beiert
AU - Leon Iden
AU - Anna Füting
AU - Raphael Spittler
AU - Sergio Richter
AU - Anja Schade
AU - Malte Kuniss
AU - Carsten Wunderlich
AU - Dong-In Shin
AU - Dirk Grosse Meininghaus
AU - Mike Foresti
AU - David Reek
AU - Uwe Wiegand
AU - Alexander Bauer
AU - Andreas Metzner
AU - Lars Eckardt
AU - Olaf Krahnefeld
AU - Christian Sticherling
AU - Michael Kühne
AU - Dinh Quang Nguyen
AU - Laurent Roten
AU - Dominik Linz
AU - Pepijn van der Voort
AU - Bart A Mulder
AU - Johan Vijgen
AU - Alexandre Almorad
AU - Charles Guenancia
AU - Laurent Fauchier
AU - Serge Boveda
AU - Yves De Greef
AU - Antoine Da Costa
AU - Pierre Jais
AU - Antoine Milhem
AU - Laurence Jesel
AU - Bruno Degand
AU - Hervé Poty
AU - Ziad Khoueiry
AU - Julien Seitz
AU - Julien Laborderie
AU - Alexis Mechulan
AU - Francois Brigadeau
AU - Alexandre Zhao
AU - Yannick Saludas
AU - Olivier Piot
AU - Nikhil Ahluwalia
AU - Claire A Martin
AU - Jian Chen
AU - Bor Antolic
PY - 2026
DA - 2026/09/01
JO - European Heart Journal Open
DO - 10.1093/ehjopen/oeag134
UR - https://doi.org/10.1093/ehjopen/oeag134
AB - 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.
SN - 2752-4191
ER -