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Updated: Jun 28, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management
Anastasios Apostolos1, Dimitrios Tsiachris1, Maria Drakopoulou1
1First Department of Cardiology, Medical School National and Kapodistrian University of Athens, Hippokration General Hospital Athens Greece.
Abstract:
This comprehensive review explores the incidence, pathophysiology, and management of atrial fibrillation (AF) following percutaneous closure of patent foramen ovale (PFO). Although AF is considered a common adverse event post PFO closure, its incidence, estimated at <5%, varies based on monitoring methods. The review delves into the challenging task of precisely estimating AF incidence, given subclinical AF and diverse diagnostic approaches. Notably, a temporal pattern emerges, with peak incidence around the 14th day after closure and a subsequent decline after the 45th day, mimicking general population AF trends. The pathophysiological mechanisms behind post PFO closure AF remain elusive, with proposed factors including local irritation, device-related interference, tissue stretch, and nickel hypersensitivity. Management considerations encompass rhythm control, with flecainide showing promise, and anticoagulation tailored to individual risk profiles. The authors advocate for a personalized approach, weighing factors like age, comorbidities, and device characteristics. Notably, postclosure AF is generally considered benign, often resolving spontaneously within 45 days, minimizing thromboembolic risks. Further studies are required to refine understanding and provide evidence-based guidelines.
Insights
Atrial fibrillation (AF) after patent foramen ovale (PFO) closure is uncommon (<5%) and often resolves within 45 days. Management involves personalized rhythm control and anticoagulation, with flecainide showing promise.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a recognized complication after percutaneous patent foramen ovale (PFO) closure.
- Estimating the true incidence of AF is challenging due to subclinical cases and varied monitoring techniques.
Purpose of the Study:
- To comprehensively review the incidence, pathophysiology, and management strategies for AF post-PFO closure.
- To explore the temporal patterns and potential mechanisms driving AF development after PFO closure.
Main Methods:
- Systematic review of existing literature on AF following percutaneous PFO closure.
- Analysis of reported incidence rates, diagnostic methods, and proposed pathophysiological mechanisms.
- Evaluation of current and potential management approaches, including pharmacotherapy and anticoagulation.
Main Results:
- Reported AF incidence is generally low (<5%), but precise estimation is difficult.
- A temporal trend shows peak AF incidence around 14 days post-closure, decreasing after 45 days.
- Potential mechanisms include local irritation, device interference, tissue stretch, and nickel hypersensitivity.
- Post-closure AF is often self-limiting, typically resolving within 45 days with minimal thromboembolic risk.
Conclusions:
- AF after PFO closure is generally benign and transient.
- Personalized management considering patient risk factors and device characteristics is recommended.
- Further research is needed to elucidate mechanisms and establish definitive guidelines.
