Incidence of atrial fibrillation after percutaneous closure of patent foramen ovale and small atrial septal defects in patients presenting with cryptogenic stroke

• Published in: International journal of stroke 2010-02, Vol.5 (1), p.4-9
• Main Authors: Bonvini, R. F., Sztajzel, R., Dorsaz, P.-A., Righini, M., Bonvin, C., Alibegovic, J., Sigwart, U., Camenzind, E., Verin, V., Sztajzel, J.
• Format: Article
• Language: English
• Subjects: 7-day event-loop-recording; Adolescent; Adult; Aged; ASD; atrial fibrillation; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - epidemiology; Brain Ischemia - complications; Cardiac Surgical Procedures; closure device; Electrocardiography; Female; Follow-Up Studies; Foramen Ovale, Patent - diagnosis; Foramen Ovale, Patent - pathology; Foramen Ovale, Patent - surgery; Heart Septal Defects, Atrial - diagnosis; Heart Septal Defects, Atrial - pathology; Heart Septal Defects, Atrial - surgery; Humans; Ischemic Attack, Transient - complications; Male; Middle Aged; percutaneous closure; PFO; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Retrospective Studies; Risk Factors; Stroke - complications; Stroke - etiology; Ultrasonography; Young Adult
• ISSN: 1747-4930; 1747-4949
• DOI: 10.1111/j.1747-4949.2009.00336.x

Objective The occurrence of atrial fibrillation after percutaneous closure of a patent foramen ovale for cryptogenic stroke has been reported in a variable percentage of patients. However, its precise incidence and mechanism are presently unclear and remain to be elucidated. Design Prospective follow-up study. Patients Ninety-two patients undergoing a percutaneous patent foramen ovale closure procedure (closure group) for cryptogenic stroke were compared with a similar group of 51 patients, who were medically treated. Methods A systematic arrhythmia follow-up protocol to assess the incidence of AF was performed including a 7-day event-loop recording at day 1, after 6 and 12 months in patients of the closure group and compared with those of the medically treated group. Results The incidence of AF was similar in both study groups during a follow-up of 12 months, including 7·6% (95% CI: 3·1–15·0%) in the closure and 7·8% (95% CI: 2·18–18·9%) in the medically treated group (P = 1·0). The presence of a large patent foramen ovale was the only significant risk factor for the occurrence of AF as demonstrated by a multivariate Cox regression analysis (95% CI, 1·275–20·018; P = 0·021). Conclusions Our findings indicate that patients with cryptogenic stroke and patent foramen ovale have a rather high incidence of AF during a follow-up of 12 months. Atrial fibrillation occurred with a similar frequency whether the patent foramen ovale/atrial septal defect was successfully percutaneously closed or was medically managed. The presence of a large patent foramen ovale was the only significant predictor of AF occurrence during follow-up.