Patients With Patent Foramen Ovale or Atrial Septal Defect Have Worse Outcomes After Pulmonary Vein Isolation

Patients with patent foramen ovale (PFO) and atrial septal defect (ASD) have increased rates of atrial fibrillation (AF) because of chronic atrial stretch and remodeling. However, the impact of these defects on outcomes after pulmonary vein isolation (PVI) remains unknown. This study aimed to determine whether preexisting PFO or ASD is associated with worse clinical outcomes following PVI. Using TriNetX, a global research network of over 130 million patients, we identified adults undergoing PVI via Current Procedural Terminology codes through November 2022. Patients with a preexisting PFO or ASD were compared with those without using propensity score matching (PSM). Outcomes included mortality, hospitalization, redo ablation, direct-current cardioversion (DCCV), antiarrhythmic drug (AAD) use, and stroke over 2 years of follow-up. We examined a total of 53 healthcare organizations and 81,442 patients without a PFO or ASD and 2,884 patients with one. After applying propensity score matching, each cohort included 2,804 patients. The average age was 63.8 years, 35.3% of patients were female, and the average left ventricular ejection fraction was 52.9%. Patients with PFO or ASD had higher rates of hospitalization (34.9% vs 30.7%; HR 1.14, 95% CI 1.04 to 1.25), direct-current cardioversion (20.9% vs 17.6%; HR 1.18, 95% CI 1.05 to 1.33), antiarrhythmic drug use (57.8% vs 53.3%; HR 1.12, 95% CI 1.05 to 1.20), and stroke (7.0% vs 5.1%; HR 1.36, 95% CI 1.09 to 1.68; all p < 0.01). Mortality and redo ablation did not differ. In patients with atrial fibrillation undergoing PVI, preexisting PFO or ASD was associated with greater markers of recurrent arrhythmia, increased hospitalizations, and more strokes.