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Long-Term Risk of AF After Transcatheter PFO Closure
Quick Takes
- Despite atrial fibrillation or flutter (AF) being a known potential procedure-related complication to transcatheter closure of patent foramen ovale (PFO), the long-term risk of developing AF following transcatheter PFO closure is unknown.
- In the present study, transcatheter PFO closure is not associated with any substantial increased long-term risk of developing AF beyond the known procedure-related risk during the first 3 months.
Study Questions:
What is the long-term risk of developing atrial fibrillation or flutter (AF) following the closure of patent foramen ovale (PFO)?
Methods:
The authors identified three nationwide cohorts in Denmark: 1) a PFO closure cohort, 2) a PFO diagnosis cohort without PFO closure, and 3) a matched general population comparison cohort. Risk of AF and multivariable-adjusted hazard ratio (HR) of the association between PFO closure or PFO diagnosis and AF were calculated.
Results:
A total of 817 patients had PFO closure, 1,224 had PFO diagnosis without closure, and 8,170 matched individuals were selected as general population control. The 5-year risk of AF was 7.8% in the PFO closure cohort, 3.1% in the PFO diagnosis cohort, and 1.2% in the matched cohort. The HR of AF comparing PFO closure with PFO diagnosis was 2.3 (95% confidence interval [CI], 1.3–4.0) within the first 3 months and 0.7 (95% CI, 0.3–1.7) thereafter. The HR of AF comparing PFO closure with the matched cohort was 51 (95% CI, 21–125) within the first 3 months and 2.5 (95% CI, 1.2–5.0) thereafter.
Conclusions:
The authors conclude that PFO closure was not associated with substantial increased long-term risk of developing AF beyond the well-known procedure-related short-term risk.
Perspective:
It is recommended that patients with cryptogenic stroke and the presence of a PFO undergo transcatheter PFO closure. It has been previously established that the PFO closure procedure is associated with an increase in the short-term risk of AF. Early AF episodes may be due to irritation or inflammation at the device/septum interface. Alternatively, the newly detected AF may be due to medical scrutiny following PFO closure. The clinical significance of AF following PFO closure remains unknown, but the protective benefits of PFO closure may be offset should there be an increase in long-term AF.
The current study employed a national database to perform a high-level comparison of patients with PFO who underwent PFO closure, patients with PFO who did not undergo the closure, and the age- and sex-matched controls. The authors found that PFO closure was only associated with an increase in short-term risk of developing AF, but long-term risk was similar in PFO patients who did not undergo PFO closure as well as the general population. One of the limitations of the present study is that patients were routinely followed only for 3 months after their procedure, and their long-term AF risk may have been under-reported. Further studies are still needed to evaluate the prognosis following post-procedural AF, including recurrent stroke.
Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Foramen Ovale, Patent, Heart Defects, Congenital, Ischemic Stroke, Risk Assessment, Secondary Prevention, Stroke, Vascular Closure Devices
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