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Updated: Jul 14, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Cardiovascular Outcomes and Readmissions of Atrial Fibrillation Among Patent Foramen Ovale Occluder Device
Amro Taha1, Shafaqat Ali2, Lalitsiri Atti3
1Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL.
Insights
Patients with patent foramen ovale (PFO) and atrial fibrillation (AF) undergoing PFO occluder device procedures had higher rates of mechanical circulatory support and stroke, but no increased mortality or readmissions. AF also led to longer hospital stays and higher costs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Patent foramen ovale (PFO) closure is a minimally invasive treatment for cryptogenic stroke.
- Limited data exists on the impact of Atrial Fibrillation (AF) in patients receiving PFO occluder devices.
Purpose of the Study:
- To investigate the impact of AF on outcomes in patients undergoing PFO occluder device procedures.
- To compare adverse events, mortality, and healthcare resource utilization between PFO patients with and without AF.
Main Methods:
- Retrospective analysis of the Nationwide Readmissions Database (2016-2019).
- Inclusion of patients who underwent PFO occluder device procedures.
- Propensity score matching (PSM) and multivariate regression to compare outcomes between PFO patients with and without AF.
- Outcomes assessed: in-hospital mortality, acute kidney injury (AKI), mechanical circulatory support (MCS) use, cardiogenic shock (CS), acute ischemic stroke, bleeding, and readmission rates.
Main Results:
- Out of 6508 hospitalizations, 13.4% of patients had AF.
- The PFO with AF group showed significantly higher rates of MCS (4.5% vs 2.2%) and stroke (7.6% vs 4.6%) compared to the PFO without AF group.
- No significant differences were observed in in-hospital mortality, CS, AKI, bleeding, or readmission rates.
- Patients with AF experienced longer hospital stays (9.5 vs 8.2 days) and higher total costs ($66,513 vs $52,013).
Conclusions:
- Atrial fibrillation in PFO occluder device recipients is associated with increased adverse outcomes, specifically higher rates of MCS use and stroke.
- There were no significant differences in mortality or readmission rates between the AF and non-AF groups.
- Further long-term follow-up studies are warranted to fully understand the implications of AF in this patient population.
Abstract:
Patent foramen ovale (PFO) occluder devices are increasingly utilized in minimally invasive procedures used to treat cryptogenic stroke. Data on the impact of Atrial Fibrillation (AF) among PFO occluder device recipients are limited. The Nationwide Readmissions Database was queried between 2016 and 2019 to identify PFO patients with and without AF. The 2 groups were compared using propensity score matching (PSM) and multivariate regression models. The outcomes included in-hospital mortality, acute kidney injury (AKI), Mechanical circulatory support use (MCS), Cardiogenic shock (CS), acute ischemic stroke, bleeding, and other cardiovascular outcomes. Statistical analysis was performed using STATA v. 17. Out of 6508 Weighted hospitalizations for PFO occluder device procedure over the study period, 877 (13.4%) had AF compared to 5631 (86.6%) who did not. On adjusted analysis, PFO with AF group had higher rates of MCS (PSM, 4.5% vs 2.2 %, P value = 0.011) and SCA (PSM, 7.6% vs 4.6 %, P value = 0.015) compared to PFO with no AF. There was no statistically significant difference in the rate of in-hospital mortality (PSM, 5.4% vs 6.4 %, P value = 0.39), CS (PSM, 8.3% vs 5.9 %, P value = 0.075), AKI (PSM, 32.4% vs 32.3 %, P value = 0.96), bleeding (PSM, 2.08% vs 1.3%, P value = 0.235) or the readmission rates among both cohorts. Additionally, AF was associated with higher hospital length of stay (9.5 ± 13.2 vs 8.2 ± 24.3 days, P-value = 0.012) and total cost ($66,513 ± $80,922 vs $52,013±$125,136, 0.025, P-value = 0.025) compared to PFO without AF. AF among PFO occluder device recipients is associated with increased adverse outcomes, including MCS use and SCA, with no difference in mortality and readmission rates among both cohorts. Long-term follow-up needs further studies.
