Atrial fibrillation following patent foramen ovale closure: A large single-center institutional experience

Background Patent foramen ovale (PFO) is a risk factor for stroke, and closure reduces this risk. However, atrial fibrillation (AF) occurs post-procedure in 3–7 % of cases. Objectives We aimed to (1) assess AF rates after PFO closure at our institution and (2) identify associated risk factors. Methods The records of 279 patients with no prior AF history who underwent PFO closure since 2019 were reviewed. Patients who developed AF were compared to a propensity matched control group of non-AF patients. The groups were assessed for occurrence of AF, comorbidities, echocardiographic parameters, and anticoagulation use. AF was reported from either loop recorder data, EKG, or emergency department or clinic documentation. Continuous variables (age, BMI, LA size, LAVI) were compared using t -tests; categorical variables (alcohol use, hypertension, hyperlipidemia, and diabetes) were assessed via odds ratios. Results AF developed in 35 patients (12.54 %), with an average onset of 100 days post-closure. Of these, 66 % were on anti-coagulation. AF patients had significantly higher alcohol use (OR = 6, p -value '0.01), older age (t = 2.3, p -value '0.03), and had a larger mean LAVI on echocardiography (t = 2.01, p-value '0.05) compared to patients who did not develop AF. Conclusions The incidence of AF is higher at our hospital compared to other institutions. The occurrence of AF seems to be concentrated in the first 4 months after PFO closure. Alcohol and age were associated with an increased risk for the development of AF post PFO closure. A greater LAVI may correlate with increased risk of developing AF.