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Published on: February 26, 2013
Atrial fibrillation following patent foramen ovale closure: A large single-center institutional experience
Arsh Issany1, Mohammad Alsheikh-Kassim1, Aman Gupta2
1Jacobs School of Medicine and Biomedical Sciences, 955 Main St, Buffalo, NY, 14203, United States of America.
Insights
Patent foramen ovale (PFO) closure can lead to atrial fibrillation (AF) in some patients. Risk factors for developing AF post-procedure include older age, higher alcohol consumption, and larger left atrial volume index (LAVI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Patent foramen ovale (PFO) is a recognized risk factor for stroke.
- PFO closure is an effective stroke risk reduction strategy.
- A known complication of PFO closure is the development of atrial fibrillation (AF), occurring in 3-7% of cases.
Purpose of the Study:
- To determine the incidence of AF following PFO closure at our institution.
- To identify patient-specific risk factors associated with new-onset AF post-PFO closure.
Main Methods:
- A retrospective review of 279 patients who underwent PFO closure without prior AF history.
- Propensity score matching was used to compare patients who developed AF with a control group.
- Analysis included comorbidities, echocardiographic parameters (LAVI), and anticoagulation status.
Main Results:
- The incidence of AF post-PFO closure was 12.54% (35 patients), with an average onset of 100 days.
- Patients who developed AF had significantly higher rates of alcohol use (OR=6), were older, and had a larger mean LAVI.
- 66% of patients who developed AF were on anticoagulation therapy.
Conclusions:
- The incidence of AF at our institution post-PFO closure exceeds reported rates.
- AF development is concentrated within the first four months following PFO closure.
- Increased alcohol use, older age, and larger LAVI are associated with a higher risk of developing AF after PFO closure.
Background:
Patent foramen ovale (PFO) is a risk factor for stroke, and closure reduces this risk. However, atrial fibrillation (AF) occurs post-procedure in 3-7 % of cases.
Objectives:
We aimed to (1) assess AF rates after PFO closure at our institution and (2) identify associated risk factors.
Methods:
The records of 279 patients with no prior AF history who underwent PFO closure since 2019 were reviewed. Patients who developed AF were compared to a propensity matched control group of non-AF patients. The groups were assessed for occurrence of AF, comorbidities, echocardiographic parameters, and anticoagulation use. AF was reported from either loop recorder data, EKG, or emergency department or clinic documentation. Continuous variables (age, BMI, LA size, LAVI) were compared using t-tests; categorical variables (alcohol use, hypertension, hyperlipidemia, and diabetes) were assessed via odds ratios.
Results:
AF developed in 35 patients (12.54 %), with an average onset of 100 days post-closure. Of these, 66 % were on anti-coagulation. AF patients had significantly higher alcohol use (OR = 6, p-value <0.01), older age (t = 2.3, p-value <0.03), and had a larger mean LAVI on echocardiography (t = 2.01, p-value <0.05) compared to patients who did not develop AF.
Conclusions:
The incidence of AF is higher at our hospital compared to other institutions. The occurrence of AF seems to be concentrated in the first 4 months after PFO closure. Alcohol and age were associated with an increased risk for the development of AF post PFO closure. A greater LAVI may correlate with increased risk of developing AF.
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