Abstract / Summary
Background: Esophageal fistula (EF) is a severe complication of atrial fibrillation (AF) ablation. Whether its clinical course varies by AF-type remains uncertain. Aims: The aim of this study was to compare EF presentation, diagnosis, management, and outcomes among patients who developed EF after paroxysmal vs. persistent AF ablation. Methods: This POTTER-AF registry subanalysis included patients with EF after AF or atrial tachycardia ablation. Results: Among 553 729 ablation procedures, 138 EF cases were identified (0.025%); data were available for 118 patients: 69 with persistent AF and 49 with paroxysmal AF. AF-type-specific procedure denominators were unavailable, precluding assessment of subtype-specific incidence or relative risk. Patients with persistent AF had lower baseline left ventricular ejection fraction (55 [45–62]% vs. 60 [58–65]%; P <0.001), longer radiofrequency application (46 [29–60] vs. 29 [20–40] min; P = 0.02), and more frequent roof-line, posterior-line, and complex fractionated atrial electrograms ablation. No statistically significant differences were observed in EF presentation, diagnostic approach, or treatment strategy. Mortality was 47/68 (69.1%) vs. 30/49 (61.2%) (absolute difference, 7.9 percentage points; 95% confidence interval, −9.2 to 24.9; P = 0.37). AF type was not independently associated with mortality after adjustment for age and left ventricular ejection fraction. Conclusions: Among patients who developed EF after AF ablation, no statistically significant differences in presentation, diagnostic approach, management, or mortality were detected across AF types, although clinically meaningful differences cannot be excluded. EF occurred across different ablation strategies, including predominantly pulmonary vein isolation-based procedures. Mortality and the burden of severe outcomes remained high in both groups. AF-type-specific incidence and relative risk could not be assessed. AF type was not independently associated with mortality.