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Interaction of cardiac implantable electronic device and patent foramen ovale in ischemic stroke: A case-only study

Kolade M Agboola1, Jin-Moo Lee2, Xiaoyan Liu3

  • 1Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.

Pacing and Clinical Electrophysiology : PACE
|January 9, 2019
PubMed

Insights

Cardiovascular implantable electronic device (CIED) leads can form clots. This study found no increased risk of stroke in patients with both a CIED and a patent foramen ovale (PFO). The presence of a CIED did not magnify the stroke risk associated with PFO.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Cardiovascular implantable electronic device (CIED) leads can serve as a site for right atrial thrombus formation.
  • Patent foramen ovale (PFO) is a potential pathway for right-to-left thromboembolism, leading to ischemic stroke.
  • The interaction between CIEDs and PFO in stroke risk is not fully understood.

Purpose of the Study:

  • To investigate whether the presence of a CIED modifies the risk of ischemic stroke in patients with a PFO.
  • To test the hypothesis that CIEDs amplify the association between PFO and stroke by promoting thrombus formation.

Main Methods:

  • A case-only study design was employed using prospectively maintained stroke registry data from 2006-2015.
  • Included were consecutive first ischemic stroke patients.
  • PFO diagnosis was based on echocardiography, and CIED presence was determined from chest radiography reports.

Main Results:

  • The study included 7089 ischemic stroke patients.
  • Prevalence of CIED was lower in patients with PFO (8.0%) compared to those without PFO (10.9%), P=0.015.
  • This finding was contrary to the initial hypothesis.

Conclusions:

  • In hospitalized ischemic stroke patients, a higher prevalence of CIED was not observed in those with PFO.
  • The presence of a CIED did not appear to increase the risk of PFO-associated ischemic stroke in the studied population.
Abstract

Keywords:
cardiovascular implantable electronic devicecase-only study designintracardiac leadsischemic strokepatent foramen ovale

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