Incidence, epidemiology, risk factors and prognosis of atrio-esophageal fistula following percutaneous catheter ablation. An exhaustive natiowide registry - 09/01/21
Résumé |
Introduction |
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.
Objective |
To determine incidence, epidemiology, risk factors and prognosis of AEF using a “ as exhaustive as possible” nationwide survey.
Method |
All French centres performing AF ablation were identified and survey were sent concerning the habits, techniques of AF ablation and eventual cases of AEF.
Results |
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).
Conclusion |
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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Vol 13 - N° 1
P. 97 - janvier 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.