Predictive score for supraventricular arrhythmia after patent foramen ovale percutaneous closure

Supraventricular arrhythmia (SVA) is the most frequent complication after patent foramen ovale (PFO) percutaneous closure.

To develop and validate a predictive score for SVA after PFO closure.

Patients with PFO closure and undergoing implantable loop recorder (ILR) monitoring were recruited in 15 French centres. The primary outcome was any SVA lasting ≥30 s within 3 months after the procedure. The score was derived from multivariable logistic regression from a training set of patients and was tested in an independent internal validation set. The score was then externally validated in a cohort of patients without ILR monitoring from the AIR FORCE registry.

Overall, 338 patients undergoing ILR monitoring (270 in the training set; 68 in the internal validation set) and 2215 not undergoing ILR monitoring (external validation set) were included. Determinants of the prognostic score were age, male sex, RoPE score, septum secundum thickness, left atrial volume and device left disc diameter. In the internal validation set, the area under the curve was 0.72 (0.58-0.87). A threshold of 55 (fourth quartile of the training set score) had a specificity of 93.3% and a positive predicted value of 72.7%. In the external validation set, the score demonstrated a similar correlation, with an observed threefold increase in the symptomatic SVA rate between the first and fourth quartiles.

This easily calculable score can be used to identify patients at high risk of developing SVA after PFO closure and may help detect candidates for a specific rhythm-monitoring strategy.