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New onset atrial fibrillation after percutaenous closure of Patent Foramen Ovale – predictors and prognostic impact
Session:
CO 16 - Congénitos
Speaker:
Luís Morais
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Luís Almeida Morais; Lidia De Sousa; António Fiarresga; José Diogo Ferreira Martins; Ana Teresa Timóteo; André Viveiros Monteiro; José Alberto Oliveira; cristina soares; Ana Figueiredo Agapito; Maria De Fátima Pinto; Rui Cruz Ferreira
Abstract
<p><strong>Background:</strong> Recently, percutaneous Patent Foramen Ovale (pPFO) closure benefits for secondary prevention in cryptogenic stroke are building up evidence. New onset atrial fibrillation has been a concern after pPFO closure with clinical trials showing ambiguous results.</p> <p><strong>Purpose</strong>: It is our aim to determinate the new onset atrial fibrillation rate and to identify its predictors, in a real population submitted to pPFO closure.</p> <p><strong>Methods:</strong> From 2000 to 2014, consecutive patients submitted to pPFO closure in a single structural intervention cardiology centre were prospectively enrolled. All patients presented a 24-hour heart rhythm monitoring and a transthoracic echocardiography with left atrial dimensions determination and atrial septum aneurysm (ASA) presence assessed as part of the previous ischemic event etiological investigation. Immediate procedural success and residual shunt determination was assessed by echocardiography and fluoroscopy during the procedure and by transesophageal echocardiography (TEE) at 1<sup>st</sup> year follow-up. During follow-up electrocardiography or 24-hour heart rhythm monitoring was used to identify new onset of atrial fibrillation.</p> <p><strong>Results: </strong>From 403 patients submitted to pPFO closure (females 52.1%, mean age 44.7±10.9 years old), 23.6% presented arterial hypertension (AHT) and 49.1% presented ASA. Pre procedural mean left atrial diameter was 35.9±5.2 mm. The most frequent device used was Amplatzer® in 81.4% of patients, followed by Atriasept® (11.4%) and Premere® (5.2%). Immediate success was achieved in 97% and 7.2% presented a residual shunt on the 1<sup>st</sup> year TEE. Mean overall follow-up time was 6.4±3.7 years. 23 patients (5.7%) showed ischemic events recurrence (19 strokes and 4 TIA). During follow-up 17 patients (4.2%) presented new onset atrial fibrillation. Independent predictors for new onset of atrial fibrillation in this population were age (OR 1.06 95%CI 1.01-1.1, p=0.012), AHT (OR 2.7 95%CI 1.1-7.4, p=0.041) and ASA (OR 3.2 95%CI 1.1-9.9, p=0.045). However, in multivariate analysis only age (OR 1.07 95%CI 1.01-1.13, p=0.015) and ASA (OR 4.01 95%CI 1.2-13.1, p=0.022) remained independent predictors. Left atrial pre pPFO closure dimensions, device type or size and the presence of residual shunt in TEE were not determinants of new onset atrial fibrillation. New onset atrial fibrillation did not show statistical correlation with ischemic events recurrence during follow-up. </p> <p><strong>Conclusion: </strong>Despite being a highly successful and safe procedure in most patients, percutaneous closure of PFO was associated with a non-negligenciable rate of new onset atrial fibrillation. Older patients and the presence of atrial septal aneurysm were found to be the best independent predictors for this outcome. Nonetheless, new onset of atrial fibrillation during follow-up was not associated with ischemic events recurrence in this population. </p>
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