Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Catheter Cardiovasc Interv. 2022 Aug;100(2):219-224. doi: 10.1002/ccd.30247. Epub 2022 Jun 1.
Determine the true incidence and time course of atrial fibrillation (AF) after patent foramen ovale closure (PFOc) using implantable loop recorders (ILR) placed during cryptogenic stroke evaluation.
Published trials report a 2%-6.6% incidence of postimplant atrial fibrillation (PIAF) after PFOc, which is probably a gross underestimation, as only patients presenting in AF were captured. Episodes of paroxysmal and silent AF would have been missed.
Of 761 patients who underwent PFOc at a single center between January 2016 and December 2020, 35 patients had an ILR implanted before PFOc, without documentation of AF, and had ≥1 month of monitoring post-PFOc. The incidence, onset, and conclusion of AF episodes were determined from a review of patient records.
The mean duration of ILR monitoring was 54.6 ± 39.4 weeks after PFOc. AF occurred in 13/35 (37%) patients. PFOc patients who developed PIAF were older than those who did not (62 ± 11 vs. 52 ± 14 years, p = 0.03). In 12/13, the initial PIAF event occurred within 4 weeks of PFOc, with the greatest frequency around 2 weeks and conclusion by 12 weeks in all. No recurrent strokes occurred during ILR monitoring.
The actual incidence of PIAF was far greater than previously reported and was significantly associated with older age at PFOc. The timing of PIAF onset and termination were consistent with a postimplant inflammatory mechanism. The higher actual PIAF incidence underscores its low stroke potential in this population. A larger prospective trial is required to validate these preliminary results.
使用在隐源性卒中评估期间放置的植入式环路记录器（ILR），确定卵圆孔未闭（PFOc）后心房颤动（AF）的真实发生率和时间进程。
已发表的试验报告称，PFOc 后植入后心房颤动（PIAF）的发生率为 2%-6.6%，这可能是严重低估，因为只有在出现 AF 的患者中才能捕获到。阵发性和无症状性 AF 的发作可能会被遗漏。
在 2016 年 1 月至 2020 年 12 月期间，在一家单中心接受 PFOc 的 761 例患者中，35 例在 PFOc 前植入了 ILR，没有 AF 的记录，并且在 PFOc 后至少有 1 个月的监测。从患者记录的回顾中确定 AF 发作的发生率、发病时间和结束时间。
ILR 监测的平均时间为 PFOc 后 54.6±39.4 周。35 例患者中有 13 例（37%）发生 AF。发生 PIAF 的 PFOc 患者比未发生 PIAF 的患者年龄更大（62±11 岁 vs. 52±14 岁，p=0.03）。在 12 例中，最初的 PIAF 事件发生在 PFOc 后 4 周内，最常见的是在 2 周左右，所有患者在 12 周内结束。在 ILR 监测期间未发生复发性中风。
PIAF 的实际发生率远高于之前报道的发生率，并且与 PFOc 时的年龄显著相关。PIAF 发病和终止的时间与植入后的炎症机制一致。更高的实际 PIAF 发生率突出了其在该人群中较低的中风潜力。需要更大的前瞻性试验来验证这些初步结果。
