Frequency of Atrial Tachyarrhythmias Following Transcatheter Closure of PFO
Frequency of Atrial Tachyarrhythmias Following Transcatheter Closure of PFO
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 ? 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.
Patent foramen ovale (PFO) is a frequent finding in young patients with cryptogenic stroke. PFO has also been related to migraine,5 platypnea-orthodoxia syndrome (condition in which shortness of breath and hypoxemia occur when upright and resolve when prone),6 and decompression illness in divers. Long-term anticoagulation and surgical closure of PFO have been used as therapeutic options, however, their results have been mixed with respect to stroke prevention. Recently, percutaneous transcatheter PFO closure techniques have been used more frequently as a therapeutic option in these patients.
Several studies have also reported varying frequencies of ATs following transcatheter closure of PFO. However, the effect of percutaneous transcatheter PFO closure techniques on ATs is not well studied. We report the frequency of ATs in patients who underwent transcatheter closure of PFO at our institution.
Methods
Abstract and Introduction
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 ? 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.
Introduction
Patent foramen ovale (PFO) is a frequent finding in young patients with cryptogenic stroke. PFO has also been related to migraine,5 platypnea-orthodoxia syndrome (condition in which shortness of breath and hypoxemia occur when upright and resolve when prone),6 and decompression illness in divers. Long-term anticoagulation and surgical closure of PFO have been used as therapeutic options, however, their results have been mixed with respect to stroke prevention. Recently, percutaneous transcatheter PFO closure techniques have been used more frequently as a therapeutic option in these patients.
Several studies have also reported varying frequencies of ATs following transcatheter closure of PFO. However, the effect of percutaneous transcatheter PFO closure techniques on ATs is not well studied. We report the frequency of ATs in patients who underwent transcatheter closure of PFO at our institution.
Methods