# Impact of age on the management and prognosis of esophageal fistula after atrial fibrillation ablation—a subanalysis of the worldwide POTTER-AF study

## TL;DR

This study examines how age affects the management and outcomes of esophageal fistula after heart ablation procedures for atrial fibrillation.

## Contribution

The study provides new insights into age-related differences in the diagnosis and treatment of esophageal fistula following AF ablation.

## Key findings

- Older patients had a shorter time to symptom onset after esophageal fistula.
- Older patients were more likely to receive endoscopic treatment without surgery.
- Older patients showed a trend toward higher fatality rates.

## Abstract

Esophageal fistula (EF) is a rare but devastating complication following atrial fibrillation (AF) ablation. Data regarding the impact of age on EF are scarce.

To study the impact of age on the management and prognosis of EF following catheter ablation for AF.

The POTTER-AF study is a worldwide registry on EF following catheter ablation for AF. A total of 553,729 patients underwent AF ablation in 214 centers between 1996 and 2022. Of them, 138 patients experienced EF, and data regarding age, management, and prognosis were available in 113 patients. The population was divided based on the median age.

The median age was 63 years; 54 patients were <63 years old (Group 1), and 59 patients were ≥63 years old (Group 2). The groups were similar regarding procedural characteristics. The older population had a shorter time to symptom onset [15.0 (6.0, 21.0) vs. 21.0 (10.0, 25.3) days; p = 0.031]. Group 2 was less likely to receive a brain CT or MRI for diagnosis (25.9% vs. 45.3%; p = 0.046). The older population was more likely to undergo endoscopic treatment without surgery (27.6% vs. 11.3%; p = 0.035). Conservative and surgical treatments were used in similar proportions. A trend toward higher fatality was noted in the older patients (72.9% vs. 56.6%; p = 0.078).

The older population had a shorter time to symptom onset, was less likely to receive a brain CT or MRI, and more likely to be treated by an endoscopic approach only. The older patient group showed a trend toward a higher fatality.

AF, atrial fibrillation; EF, esophageal fistula; EP, electrophysiological.

AF, atrial fibrillation; EF, esophageal fistula; EP, electrophysiological.