What is the incidence of atrial fibrillation after PFO closure?
Previous literature said <10% but that was based on symptoms alone. This center in Paris took patients undergoing closure who were high risk for afib (older than 55, other CV RFs, prior palps, or SV ectopy during previous monitoring) and gave them loops. The rest of the patients got an external monitor. I love it when the answer to my question is easy to find.
At one month, just over 20% of patients had some sort of supraventricular arrhythmia (afib, aflutter, SVT - mostly afib). Of these patients, most of them met the 6 minutes of fib criteria, but less than half had it last over an hour (I've previously explored how much afib is "enough" to merit treatment - let me know if you want that email).
The rate is definitely higher than I realized - but I'm not sure of management implications. The authors share that the arrhythmias were associated with more medical encounters but not more strokes in their f/u period, and their discussion delves into some of the more strongly associated factors, including older age, male sex, and large diameter (first and last ones are unsurprising). They also found that the arrhythmias that occurred pretty much happened in the first month, which I do think is helpful information in terms of management.
Figure 1. Cumulative Incidence of New Onset of Supraventricular Arrhythmia During the First 28 Days of External Loop Recorder Monitoring and First Year of Implantable Loop Recorder Monitoring
Overall, my take is interesting and perhaps a lower threshold to look but not enough to look routinely. But, my interest is piqued and this is a space I'll be watching. Would love any thoughts that any of you have, too.
Guedeney P, Laredo M, Zeitouni M, et al. Supraventricular Arrhythmia Following Patent Foramen Ovale Percutaneous Closure. JACC: Cardiovascular Interventions. 2022;15(22):2315-2322. doi:https://doi.org/10.1016/j.jcin.2022.07.044
