Imtiaz Komal, Ebrahim Mohammed, Niu Jianli, Roberts Jonathan
Department of Cardiovascular Disease, Memorial Healthcare System, Hollywood, Florida.
J Soc Cardiovasc Angiogr Interv. 2024 Jun 4;3(7):101930. doi: 10.1016/j.jscai.2024.101930. eCollection 2024 Jul.
Patent foramen ovale (PFO) is seen in 25% of the general population but in up to 50% of patients ≤60 years old with cryptogenic strokes. Trials have shown that PFO closure vs medical therapy reduces the risk of future strokes. PFO closure may cause atrial fibrillation (AF), with prior trials reporting an incidence of 2% to 11.9%. However, the true incidence of AF after PFO closure is unknown due to limitations in prior studies for long-term monitoring.
This is a retrospective observational study at a single center. Patients who underwent PFO closure and had an implantable loop recorder prior to PFO closure were included. The final review included 38 patients who had at least 2 months of implantable loop recorder data post-PFO closure.
Ten out of 38 (26%) patients developed AF post-PFO closure. The median time to the first episode of AF was 3.95 weeks, with 40% having their first AF episode after 3 months. Median duration of AF episodes was 1 hour. One hundred percent had spontaneous termination of AF. Of the AF patients, 70% were started on oral anticoagulant therapy.
Our review shows a higher incidence of AF post-PFO closure as compared with most reported prior studies. We recommend larger prospective studies to explore the true incidence of AF post-PFO closure, its clinical impact, and subsequent stroke risk.
卵圆孔未闭（PFO）在普通人群中的发生率为25%，但在60岁及以下不明原因卒中患者中的发生率高达50%。试验表明，与药物治疗相比，封堵PFO可降低未来卒中风险。PFO封堵可能会导致心房颤动（AF），既往试验报告的发生率为2%至11.9%。然而，由于既往长期监测研究存在局限性，PFO封堵术后AF的真实发生率尚不清楚。
这是一项在单一中心进行的回顾性观察性研究。纳入在PFO封堵术前植入了植入式环路记录仪的接受PFO封堵的患者。最终纳入38例在PFO封堵术后至少有2个月植入式环路记录仪数据的患者。
38例患者中有10例（26%）在PFO封堵术后发生AF。首次发生AF的中位时间为3.95周，40%的患者在3个月后首次发生AF。AF发作的中位持续时间为1小时。100%的AF患者房颤自发终止。在发生AF的患者中，70%开始接受口服抗凝治疗。
我们的综述显示，与既往大多数报道的研究相比，PFO封堵术后AF的发生率更高。我们建议开展更大规模的前瞻性研究，以探索PFO封堵术后AF的真实发生率、其临床影响以及随后的卒中风险。
