A rare but often fatal complication of atrial fibrillation (AF) ablation is the formation of an atrioesophageal fistula (AEF) whose true prevalence and risk factors remain obscure.
To determine incidence, epidemiology, risk factors and prognosis of AEF using a “ as exhaustive as possible” nationwide survey.
All French centres performing AF ablation were identified and survey were sent concerning the habits, techniques of AF ablation and eventual cases of AEF.
Eighty-two of the 103 centres (80%) performing ablation of AF in France were included in the study performing 129286 ablations from 2006 (93% of the total AF ablation in France). Thirty-three fistula were declared (0.026% risk per procedure) with a stable annual incidence over time, unchanged after the advent of thermal probe. The survey had been completed for 30 of the 33 fistula cases (26 AEF, 4 esopericardial fistula). Sensitivity of CT scan for AEF diagnosis was 81%. Mortality was 60%, significantly lower in case of surgical management (31 vs. 93%, P=0.001). No case of AEF happened after cryo-ablation and only two AEF occurred in redo-ablation. In multivariate analysis, lack of use of contact force catheters and the realisation of posterior/roof ablation lines emerged as independent factors associated with the risk of AEF with OR 23.6 (95% CI [4.5; 21]) P=0.0002 and OR 3.7 (95% CI [1.1, 13]) P=0.04) while the lack of thermal probes remained of borderline significance (Fig. 1).
The rate of AEF after AF ablation in a nationwide and well exhaustive survey can be evaluated to 0.026% with an annual incidence remaining stable over time. A normal CT scan does not rule out the diagnosis. Prognosis remains poor with a mortality of 60% and crucially dependant of immediate surgical correction.
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Publié par Elsevier Masson SAS.