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Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence
10:52

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

Published on: December 23, 2022

Cardioembolic stroke in patients with patent foramen ovale and implanted cardiac leads

Christopher V DeSimone1, Daniel C DeSimone, Donald J Hagler

  • 1Department of Internal Medicine, Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.

Pacing and Clinical Electrophysiology : PACE
|October 20, 2012
PubMed

Insights

Cardiac device leads can cause stroke in patients with a patent foramen ovale (PFO). PFO closure may be necessary to prevent paradoxical cardioembolism in these high-risk individuals.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Implanted cardiac devices like pacemakers and defibrillators can develop thrombus on intravascular leads.
  • Patent foramen ovale (PFO) is a common condition, present in about 25% of adults.
  • The link between cardiac device leads, PFO, and stroke is not well-established.

Observation:

  • A case series of four patients presented with cardioembolic stroke.
  • These strokes were presumed to originate from intravascular cardiac leads in the presence of a PFO.
  • All four patients required device closure of their PFO.

Findings:

  • Intravascular cardiac lead thrombus in patients with PFO may be a source of paradoxical cardioembolism.
  • This case series suggests a potential mechanism for stroke in patients with both cardiac implants and PFO.
  • Device closure of PFO was a necessary intervention in these cases.

Implications:

  • Highlights a potential, underrecognized cause of stroke in patients with cardiac devices and PFO.
  • Suggests that PFO closure should be considered in patients experiencing unexplained cardioembolic stroke with indwelling cardiac leads.
  • Emphasizes the importance of evaluating for PFO in patients with cardiac device-related thromboembolic events.

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