Open Access

Sorin S. Popescu, Zeynep G. Demirtakan, Vanessa Schmidt, Helmut Pürerfellner, Philipp Sommer, Christian Sohns, Christian Veltmann, Daniel Steven, K. R. Julian Chun, Philippe Maury, Estelle Gandjbakhch, Mikael Laredo, Stephan Willems, Thomas Beiert, Leon Iden, Anna Füting, Raphael Spittler, Sergio Richter, Anja Schade, Malte Kuniss, Carsten Wunderlich, Dong-In Shin, Dirk Grosse Meininghaus, Marc Bonsels, David Reek, Uwe Wiegand, Alexander Bauer, Andreas Metzner, Lars Eckardt, Olaf Krahnefeld, Christian Sticherling, Michael Kühne, Dinh Quang Nguyen, Laurent Roten, Dominik Linz, Pepijn van der Voort, Bart A. Mulder, Johan Vijgen, Alexandre Almorad, Charles Guenancia, Laurent Fauchier, Serge Boveda, Yves De Greef, Antoine Da Costa, Pierre Jais, Antoine Milhem, Laurence Jesel, Rodrigue Garcia, Hervé Poty, Ziad Khoueiry, Julien Seitz, Julien Laborderie, Alexis Mechulan, Francois Brigadeau, Alexandre Zhao, Yannick Saludas, Olivier Piot, Nikhil Ahluwalia, Claire Martin, Jian Chen, Bor Antolic, Georgios Leventopoulos, Emin Evren Özcan, Hikmet Yorgun, Serkan Cay, Kivanc Yalin, Maichel Sobhy Botros, Ewa Jędrzejczyk-Patej, Osamu Inaba, Ken Okumura, Koichiro Ejima, Houman Khakpour, John N. Catanzaro, Vivek Reddy, Andrea Natale, Hermann Blessberger, Bing Yang, Julia Vogler, Karl-Heinz Kuck, José Luis Merino, Ahmad Keelani, Christian-H. Heeger, Roland Richard Tilz

• Background: Esophageal fistula (EF) is a rare but devastating complication following atrial fibrillation (AF) ablation. Data regarding the impact of age on EF are scarce. Objective: To study the impact of age on the management and prognosis of EF following catheter ablation for AF. Methods: 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. Results: 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 forBackground: Esophageal fistula (EF) is a rare but devastating complication following atrial fibrillation (AF) ablation. Data regarding the impact of age on EF are scarce. Objective: To study the impact of age on the management and prognosis of EF following catheter ablation for AF. Methods: 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. Results: 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). Conclusion: 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.…