Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale

Abstract

Background: Transcatheter closure of patent foramen ovale (PFO) in patients with a history of cryptogenic stroke is performed with increasing frequency. However, the long-term effects of these closure devices on atrial tachyarrhythmias (ATs) are not known.

Methods and results: The study population included 71 patients [31 (44%) men, aged 54 +/- 14 years] with PFO, diagnosed by transesophageal echocardiography (TEE), and greater than or equal to 1 cryptogenic stroke (n = 70) or orthodoxia (n = 1). Patients underwent transcatheter closure of PFO using a 28 mm (n = 53) or a 33 mm (n = 18) CardioSEAL closure device (n = 67) or an Amplatzer occluder (n = 4). Five (7%) patients presented with newly diagnosed (n = 4) or recurrent (n = 1) episodes of AT (3 atrial fibrillation and 2 typical atrial flutter) within 1 to 480 days following the procedure, with an average time to onset of 175 +/- 221 days. ATs were more frequent in those who received a 33 mm device than those who received a 28 mm device [4/18 (22%) vs. 1/53 (2%); p < 0.05]. Patients with ATs showed a trend toward a larger left atrium only on apical view (6.5 +/- 1.4 cm vs. 5.1 +/- 0.9 cm; p = 0.05). However, the difference in left atrial size on parasternal view and right atrial size between the 2 groups was not statistically significant (4.5 +/- 1.1 cm vs. 3.7 +/- 0.8 cm and 5.9 +/- 2.4 cm vs. 4.6 +/- 0.7 cm). Conclusion. Compared to the age-matched population, sustained ATs appear to be relatively common following transcatheter closure of PFO. In our series, they seemed to occur more frequently in patients who received larger devices.