Sex-Based Differences in the Management and Outcomes of Oesophageal Fistula Following Atrial Fibrillation Ablation: A Subanalysis of the Worldwide POTTER-AF Study

Résumé fourni par la source

Abstract 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.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.