Supraventricular Arrhythmia Following Patent Foramen Ovale Percutaneous Closure

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Previous studies underestimated atrial fibrillation (AF) rates post-patent foramen ovale (PFO) closure (<6%) due to reliance on symptomatic patient reports.
• The true incidence and timing of AF after PFO closure remain largely unknown.

Purpose of the Study:

• To prospectively determine the incidence, timing, and predictors of supraventricular arrhythmia after PFO closure.
• To utilize loop recorder monitoring for accurate detection of post-procedural arrhythmias.

Main Methods:

• 225 patients undergoing PFO closure were monitored using implantable or external loop recorders for at least 28 days.
• The primary endpoint was the incidence of AF, atrial flutter, or supraventricular tachycardia >30 seconds within 28 days.
• Logistic regression analysis identified determinants of the primary endpoint.

Main Results:

• Supraventricular arrhythmia occurred in 20.9% of patients (47/225) within 28 days post-PFO closure.
• The median delay from procedure to arrhythmia diagnosis was 14 days.
• Older age, larger device diameter (≥25 mm), and male sex were associated with increased risk.

Conclusions:

• Supraventricular arrhythmia is diagnosed in 1 in 5 patients after PFO closure, with a median delay of 14 days.
• These findings suggest that post-procedural arrhythmias following PFO closure have been significantly underestimated.
• Continuous cardiac monitoring is crucial for accurate assessment of arrhythmia incidence and timing.