Serkan Cay

Aims: Oesophageal fistula (OF) is a rare but life-threatening complication of atrial fibrillation (AF) ablation. Data on sex-related differences in its management and outcomes are limited. Methods and results: The PrOgnosis following oesophageal fisTula formaTion in patients undergoing cathetER ablation for AF study is a global, multicentre study evaluating the incidence, management, and outcome of OF following AF ablation. Among 553 729 patients treated across 214 centres in 35 countries between 1996 and 2022, 138 developed OF. Sex-specific data on management and outcome were available in 117 cases and are analysed herein. Females comprised 47% of the analysed cohort. Baseline characteristics, ablation modality, and use of oesophageal temperature monitoring were not different between sexes in patients developing OF. Fewer women received proton pump inhibitors post-procedure (64.8% vs. 84.7%; P = 0.017). Among patients with OF, less women developed atrio-OF (90.9% vs. 100%; P = 0.021). Oesophageal perforation and oesophageal–pericardial fistula occurred exclusively in females. The median duration until symptoms onset was 20 days for women and 16.5 days for men (P = 0.14). Echocardiography was more frequently used in women (36.4% vs. 15%; P = 0.01). Stroke was more common in women (32.7% vs. 14.8%; P = 0.040), however only before adjusting for potential cofounders. Other complications were comparable. Women underwent endoscopic therapy more often (35.8% vs. 17.7%; P = 0.034) and surgical treatment alone less frequently (28.3% vs. 51.6%; P = 0.014). Fatality rates were high and not different (63.6% in women vs. 67.2% in men; P = 0.70). Conclusion: While OF incidence for each sex could not be calculated, nearly half of all patients with OF were female. Women underwent more often endoscopic and less often surgical interventions; outcomes were comparable.

Background: Left bundle branch area pacing (LBBAP) is emerging as a physiological alternative to conventional pacing, particularly in elderly patients. Stylet‐driven leads (SDL) offer unique procedural advantages, but data on their safety and efficacy in octogenarians remain sparse. Objective: This study evaluates the feasibility, safety, and outcomes of SDL for LBBAP in octogenarians. Methods: A retrospective, single‐center study included 117 octogenarian patients (≥80 years) and 308 younger patients (p = 0.031) and higher pacing thresholds at implantation (1.03 ± 0.56 V vs. 0.82 ± 0.42 V, p = 0.001). At 12 months, event‐free survival was 91.4% in octogenarians and 94.8% in younger patients ( p = 0.288). The overall complication rate was low (5.1% vs. 3.6%, p = 0.957), and no significant differences in pacing parameters were observed between groups. Improvements in left ventricular ejection fraction (LVEF) and QRS duration were consistent across both cohorts. Conclusion: SDLs are safe and effective for LBBAP in octogenarians, providing high procedural success and significant clinical improvements. These findings highlight the potential of SDL as a viable option for elderly patients requiring physiological pacing, addressing the unique challenges posed by advanced age.

Background: Atrial fibrillation (AF) recurrence remains a significant challenge in heart failure with reduced ejection fraction (HFrEF) patients undergoing cryoballoon ablation (CBA). Sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits, including antiarrhythmic effects. This study assesses the impact of SGLT2i on AF recurrence and clinical outcomes in HFrEF patients undergoing CBA. Methods: This retrospective cohort study was conducted on 246 HFrEF patients (LVEF < 40%) undergoing CBA between January 2022 and June 2024. Patients were categorized into two groups: SGLT2i users ( n = 71) and nonusers ( n = 175). The primary endpoint was AF recurrence (> 30 s post‐blanking period). Secondary endpoints included all‐cause mortality and heart failure (HF)‐related hospitalizations. Results: The median follow‐up period was 347   days. AF recurrence was lower in the SGLT2i group (25.4% vs. 39.4%, p = 0.036). Kaplan–Meier analysis demonstrated higher recurrence‐free survival in SGLT2i users (74.6% vs. 60.6%, log‐rank p < 0.001). Cox regression confirmed SGLT2i as an independent predictor of reduced AF recurrence (HR: 0.546, 95% CI: 0.262–0.874, p = 0.011). Mortality (9.9% vs. 14.9%, p = 0.039) and HF hospitalizations (16.9% vs. 23.4%, p = 0.014) were also significantly lower in SGLT2i users. Conclusion: SGLT2i use was independently associated with lower AF recurrence, mortality, and HF‐related hospitalizations in HFrEF patients undergoing CBA. These findings highlight the potential of SGLT2i as adjunctive therapy for AF management, necessitating further prospective studies to validate these results and optimize treatment strategies.