Atrial fibrillation after transcatheter patent foramen ovale closure: To measure is to know

A patent foramen ovale (PFO) results from an incomplete fusion of the septum primum and secundum at birth. 1 Collado F.M.S. Poulin M.F. Murphy J.J. Jneid H. Kavinsky C.J. Patent foramen ovale closure for stroke prevention and other disorders. J Am Heart Assoc. 2018; 7e007146 Crossref PubMed Scopus (43) Google Scholar The prevalence of a PFO in the adult population has been estimated at approximately 25%, but this rate was highly dependent on the diagnostic modality used and selection bias by including a disproportionate number of patients with previous cryptogenic stroke in comparative studies. 2 Koutroulou I. Tsivgoulis G. Tsalikakis D. et al. Epidemiology of patent foramen ovale in general population and in stroke patients: a narrative review. Front Neurol. 2020; 11: 281 Crossref PubMed Scopus (38) Google Scholar The causal relation between cryptogenic stroke and the presence of a PFO has long been debated, yet with rates up to 40% the prevalence for PFOs is significantly higher in patients with cryptogenic stroke. 1 Collado F.M.S. Poulin M.F. Murphy J.J. Jneid H. Kavinsky C.J. Patent foramen ovale closure for stroke prevention and other disorders. J Am Heart Assoc. 2018; 7e007146 Crossref PubMed Scopus (43) Google Scholar Several additional echocardiographic markers have been associated with increased risk of stroke, such as the presence of an atrial septal aneurysm or right–left shunting. In 1975, the first successful transcutaneous atrial septal defect closure was performed, after which the technique kept evolving with the development of dedicated PFO occluding devices. 1 Collado F.M.S. Poulin M.F. Murphy J.J. Jneid H. Kavinsky C.J. Patent foramen ovale closure for stroke prevention and other disorders. J Am Heart Assoc. 2018; 7e007146 Crossref PubMed Scopus (43) Google Scholar In clinical trials with >5 years of follow-up, transcatheter PFO closure was superior to medical therapy in the prevention of recurrent stroke. 3 Messe S.R. Gronseth G.S. Kent D.M. et al. Practice advisory update summary: patent foramen ovale and secondary stroke prevention: report of the Guideline Subcommittee of the American Academy of Neurology. Neurology. 2020; 94: 876-885 Crossref PubMed Scopus (57) Google Scholar As such, current guidelines recommend PFO closure in patients with cryptogenic stroke after exclusion of alternative causes. 3 Messe S.R. Gronseth G.S. Kent D.M. et al. Practice advisory update summary: patent foramen ovale and secondary stroke prevention: report of the Guideline Subcommittee of the American Academy of Neurology. Neurology. 2020; 94: 876-885 Crossref PubMed Scopus (57) Google Scholar Incidence of new-onset atrial fibrillation after transcatheter patent foramen ovale closure using 15 years of Ontario administrative health dataHeart RhythmVol. 19Issue 9PreviewIndividuals 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). Full-Text PDF