Incidence of Atrial Fibrillation Post Patent Foramen Ovale (PFO) Closure: A Meta-analysis

Transcatheter patent foramen ovale (PFO) closure is the treatment of choice in younger patients with cryptogenic stroke or high-risk PFO features. A common complication post-procedurally is atrial fibrillation or flutter (AF/Af). In this study, we evaluate the incidence of AF/Af following PFO closure compared to medical therapy, the time to occurrence, and the role of age in AF/Af occurrence.

A systematic literature search was conducted in MEDLINE (Pubmed) and Scopus databases for studies assessing the incidence of AF/Af post-PFO closure in contrast to medical therapy, the incidence within the 1^st month post-procedurally or later, and the role of age in AF/Af occurrence.

Twenty-nine studies (10 randomized, 18 observational, 1 case-control) were included in this systematic review, of which 10 (7 randomized, 3 observational) were meta-analyzed. Subjects undergoing PFO closure were at higher risk of developing AF/Af (RR: 2.27, 95% CI: 1.29, 4.01, p=0.009). There was a trend for higher AF/Af rates within the 1st month post-intervention. There was no statistical difference after the 1^st month of follow-up (3 studies, RR: 0.60, 95% CI: 0.02-19.88, p=0.60). Mean age of participants did not affect the primary endpoint (β: -0.03, CI: - 1.13, 0.06, p=0.45, residual I²=44%, R²=4%).

AF/Af risk is elevated following PFO closure, particularly early post-procedure, likely due to procedural factors. However, the arrhythmias are often transient and not agedependent. Study heterogeneity and limited monitoring methods may affect the reported incidence.

PFO closure increases short-term AF/Af risk compared to medical therapy, but the events are typically mild and age-independent. This should be weighed against the long-term benefit of stroke prevention. Moreover, standardized monitoring is needed to better define this risk.