Incidence of new-onset atrial fibrillation after transcatheter patent foramen ovale closure using 15 years of Ontario administrative health data

Abstract

Background: Individuals with patent foramen ovale (PFO) routinely undergo transcatheter closure (TC) for secondary prevention of recurrent stroke. However, some evidence suggests that TC may increase the risk of new-onset atrial fibrillation (AF).

Objective: The purpose of this study was to evaluate the risk of new-onset AF following PFO closure and to explore predictors of AF development.

Methods: We created a retrospective cohort of all Ontarians over 18 years of age who received TC between October 2002 and December 2017 using administrative health data and the CorHealth cardiac registry. Poisson regression determined event rates of AF and secondary outcomes such as stroke and mortality per 1000 person-years. A multivariable Cox proportional hazards model identified predictors of new-onset AF following TC.

Results: Of 1533 patients, 96 (6.26%) developed new-onset AF following PFO closure, over average follow-up time of 8.2 years. Age >60 years (hazard ratio [HR] 2.82; 95% confidence interval [CI] 1.76-4.51; P <.001) and diabetes (HR 2.49; 95% CI 1.48-4.18; P <.001) were statistically significant, independent predictors of AF according to the Cox model.

Conclusions: The incidence of new-onset AF after PFO closure was relatively low. Having diabetes and age >60 years were the most important factors associated with new-onset AF in this population.

Keywords: Atrial fibrillation arrhythmia; Patent foramen ovale; Patent foramen ovale closure; Percutaneous transcatheter closure; Survival analysis.