Background: Oesophageal fistula represents a rare but dreadful complication of atrial fibrillation catheter ablation. The POTTER-AF study presented its incidence, management and outcome. The time course of management and outcome has not been evaluated up to date.

Aims:  In this POTTER-AF sub-study we evaluated the time course of OF formation to evaluate weather increasing knowledge of OF prevention and management could potentially reduce the rate of death and sequalae.

Methods: The international multicenter POTTER-AF study included 138 OF patients from a total of 553,729 patients with catheter ablation procedures. In 116/138 (84%) patients the date of the procedure was available, all other patients were excluded from this sub study analysis. Based on the date of the procedure the patients were devided into 3 groups (T1: 2004 – 08/2014, n=39 patients; T2: 08/2014-04/2018, n= 39 patients; T3: 05/2018 – 10/2022, n = 38 patients).

Results: Postprocedural proton pump inhibitors were prescribed in 71.6% (T1: 51.3%, T2: 76.9%, T3: 86.8%, p=0.017) of patients while an esophagus temperature probe was utilized in 24.1% (T1: 17.9%, T2: 35.9%, T3: 18.4%, p=0.107) of patients. Oesophageal surgery was performed in 39.7% (T1: 28.2%, T2: 46.2%, T3: 44.7%, p=0.198) of patients. Direct endoscopic treatment in 19.0% (T1: 17.9%, T2: 23.1%, T3: 15.8%, p=0.703) of patients. Conservative treatment was performed in 32.8% (T1: 43.6%, T2: 17.9%, T3: 36.8%, p=0.044) of patients. The overall mortality was 65.5% (T1: 56.4%, T2: 71.8%, T3: 68.4%, p=0.324). The rate of major sequalae was 9.4% (T1: 12.8%, T2: 12.8%, T3: 2.6%, p=0.213), the rate of minor sequalae was 9.4% (T1: 17.9%, T2: 5.1%, T3: 5.3%, p=0.086). No sequelae were reported in was 13.4% (T1: 10.3%, T2: 10.3%, T3: 21.1%, p=0.286).

Conclusions: Despite increasing knowledge and prescription of proton pump inhibitors over the last 20 years the mortality and rate of major and minor sequela remains high in patients with OF.