New onset atrial fibrillation after patent foramen ovale closure

Catheter Cardiovasc Interv. 2009 Nov 15;74(6):889-95. doi: 10.1002/ccd.22172.


Objectives: In this study, we evaluated the incidence of new onset atrial fibrillation (symptomatic or detected by routine ECG) after patent foramen ovale (PFO-) closure.

Background: Although atrial fibrillation is known to occur in some patients following patent foramen ovale closure, the incidence and the risk associated with each device is not well known.

Methods: We evaluated 1,349 consecutive patients who underwent PFO closure with an approved device and examined the incidence and risk factors associated with the development of atrial fibrillation. The patients had a mean age of 50 years and underwent PFO closure for cerebrovascular accident in 696 (51.6%), transient ischemic attack in 610 (45.2%), paradoxical embolism in 22 (1.6%), decompression sickness in 13 (0.9%), and other reasons including migraine headaches in 6 (0.4%) of cases.

Results: Over a mean follow-up period of 38.1 +/- 28 months, 53 (3.9%) patients developed new onset atrial fibrillation, which is higher compared with an age-matched population. Of these, 33 (62.3%) patients developed atrial fibrillation within 4 weeks and 8 (15%) within 6 months following PFO closure (totally 77% from 0 to 6 months). The event consisted of a single paroxysm lasting less than 48 hr in 23 patients, resolving either spontaneously or with cardioversion. 40 (75.5%) patients were symptomatic at the time of diagnosis. Thirty (56.6%) patients developed chronic atrial fibrillation. On multivariate analysis, advanced age and use of the STARFlex device predicted atrial fibrillation.

Conclusions: The number of patients in whom atrial fibrillation was detected was relatively low. It is often a self-limited complication of PFO closure that may occur more frequently in elderly patients and those treated with the STARFlex device.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / etiology*
  • Atrial Fibrillation / therapy
  • Cardiac Catheterization / adverse effects*
  • Cardiac Catheterization / instrumentation
  • Chronic Disease
  • Electrocardiography
  • Female
  • Foramen Ovale, Patent / therapy*
  • Humans
  • Incidence
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Prosthesis Design
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Septal Occluder Device / adverse effects*
  • Time Factors
  • Treatment Outcome
  • Young Adult