Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: A prospective study

Leclercq, Florence; Odorico, Xavier; Marin, Grégory; Macia, Jean Christophe; Delseny, Delphine; Agullo, Audrey; Pages, Laurence; Robert, Pierre; Lattuca, Benoît; Cayla, Guillaume; Roubille, François; Gaillard, Nicolas; Arquizan, Caroline; Akodad, Mariama

doi:10.1016/j.ijcha.2021.100919

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…The lack of consensus about recurrent CVEs and AF occurring after PFO closure, and the detection of different incidences in follow-ups with ECG, Holter, and event recorder, make it necessary to use simpler and common parameters. [4][5][6] The electrocardiographic parameters related to PW characteristics-specifically PWmax, PWmin, PWdis, PWPT, and PWPTF -provide valuable insights into their potential associations with AF. 25 These parameters serve as important markers of atrial electrophysiology, offering a window into the underlying substrate that may contribute to the initiation and maintenance of AF.…”

Section: Discussionmentioning

confidence: 99%

“…4, 5 While most cases resolve spontaneously without causing ischemic events, some may progress to permanent AF and lead to recurrent ischemic events. 6,7 Although the underlying pathophysiology has not been fully elucidated, regardless of the cause, identifying the factors predictive of AF is crucial for early diagnosis and meticulous patient management. 8 Silent forms of AF, which traditional methods cannot detect, pose a challenge in the diagnosis and treatment of this condition.…”

Section: Introductionmentioning

confidence: 99%

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Temporal alterations in P-wave electrocardiographic metrics post patent foramen ovale closure: a retrospective study

ERDOĞAN,

GENC

2024

Anatolian Current Medical Journal

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Aims: This study aimed to analyze the electrocardiograms (ECG) of 69 patients before and after patent foramen ovale (PFO) closure, specifically investigating novel ECG parameters, over a 6-month post-procedure period. Methods: ECGs from 69 patients undergoing PFO closure were examined at three time points: before the procedure, and at 1st and 6th months post-procedure. A comprehensive set of ECG parameters, including P-wave (PW) maximum (PWmax), PW minimum (PWmin), PR interval, PW dispersion (PWdis), PW peak time in lead D2 (PWPTD2), PW peak time in lead V1(PWPTV1), P-axis, PW terminal force in the V1 (PWTF) and heart rate, were analyzed using a generalized linear mixed model (GLMM). Results: The GLMM analysis revealed significant changes in novel ECG parameters at 1-month post-procedure compared to baseline values. Parameters including PWmax (OR=8.898, 95% CI 7.521-10.275, p<0.001, PWmin (OR=6.579, 95% CI 5.611-7.548, p<0.001), PR (OR=4.159,95% CI 3.031-5.288, p<0.001), PWdis (OR=2.594, 95% CI 1.607-3.581, p<0.001), PWPTD2 (OR=4.261, 95% CI 2.928-5.593, p<0.001), PWPTV1 (OR=5.261, 95% CI 4.529-5.992, p<0.001), and PWTF (OR= 5.781, 95% CI 2.083-16.044, p<0.001) exhibited notable alterations, indicating a transient impact on cardiac conduction. However, these changes returned to baseline values by the 6-month follow-up. No statistically significant differences were observed in P-axis and heart rate across all time points. Conclusion: The analysis of ECG in patients undergoing PFO closure highlighted dynamic changes in novel ECG parameters in the early post-procedural period, with subsequent normalization by 6 months. Further research is warranted to elucidate the clinical implications of these dynamic electrocardiographic shifts and their potential association with long-term cardiovascular outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Temporal alterations in P-wave electrocardiographic metrics post patent foramen ovale closure: a retrospective study

ERDOĞAN,

GENC

2024

Anatolian Current Medical Journal

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“…The incidence of AF occurring after percutaneous PFO closure due to ischaemic stroke is likely underestimated in randomised trials and literature data, since only symptomatic AF is detected 1 2 5 6 20–22. In patients with systematic investigation of possible AF using Holter ECG monitoring or ICMs, the incidence rises to 20.9% in the 28 days following PFO closure 16 17.…”

Section: Discussionmentioning

confidence: 99%

Incidence of atrial fibrillation in cryptogenic stroke with patent foramen ovale closure: protocol for the prospective, observational PFO-AF study

Badoz,

Derimay,

Serzian

et al. 2023

BMJ Open

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IntroductionAfter closure of patent foramen ovale (PFO) due to stroke, atrial fibrillation (AF) occurs in up to one in five patients. However, data are sparse regarding the possible pre-existence of AF in these patients prior to PFO closure, and about recurrence of AF in the long term after the procedure. No prospective study to date has investigated these topics in patients with implanted cardiac monitor (ICM). The PFO-AF study (registered with ClinicalTrials.gov under the numberNCT04926142) will investigate the incidence of AF occurring within 2 months after percutaneous closure of PFO in patients with prior stroke. AF will be identified using systematic ICM. Secondary objectives are to assess incidence and burden of AF in the 2 months prior to, and up to 2 years after PFO closure.Methods and analysisProspective, multicentre, observational study including 250 patients with an indication for PFO closure after stroke, as decided by interdisciplinary meetings with cardiologists and neurologists. Patients will undergo implantation of a Reveal Linq device (Medtronic). Percutaneous PFO closure will be performed 2 months after device implantation. Follow-up will include consultation, ECG and reading of ICM data at 2, 12 and 24 months after PFO closure. The primary endpoint is occurrence of AF at 2 months, defined as an episode of AF or atrial tachycardia/flutter lasting at least 30 s, and recorded by the ICM and/or any AF or atrial tachycardia/flutter documented on ECG during the first 2 months of follow-up.Ethics and disseminationThe study was approved by the Ethics Committee ‘Comité de Protection des Personnes (CPP) Sud-Méditerranéen III’ on 2 June 2021 and registered with ClinicalTrials.gov (NCT04926142). Findings will be presented in national and international congresses and peer-reviewed journals.Trial registration numberNCT04926142.

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New-onset atrial fibrillation after percutaneous patent foramen ovale closure: a meta-analysis

et al. 2023

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Background The exact incidence and predictors of new-onset atrial fibrillation (AF) after percutaneous closure of patent foramen ovale (PFO) are unknown. Objective We sought to find post-procedural AF incidence rates and differences due to different screening strategies and devices. Methods A systematic search was conducted in Cochrane, MEDLINE and EMBASE. Controlled trials fulfilling the inclusion criteria were included into this meta-analysis. The incidence of new-onset AF was the primary outcome. Further parameters were surveillance strategy, device type, AF treatment and neurological events. New AF was determined as early onset within one month after implantation and late thereafter. Results 8 controlled trials and 16 cohort studies were eligible for quantitative analysis. 7643 patients received percutaneous PFO closure after cryptogenic stroke or transient ischaemic attack, 117 with other indications, whereas 1792 patients formed the control group. Meta-analysis of controlled trials showed an AF incidence of 5.1% in the interventional and 1.6% in the conservative arm, respectively (OR 3.17, 95% CI 1.46–6.86, P = 0.03, I2 = 55%). 4.7% received high-quality surveillance strategy with Holter-ECG or Loop recorder whereby AF incidence was overall higher compared to the low-quality group with 12-lead ECG only (3.3–15% vs. 0.2–4.3%). Heterogeneous results on time of AF onset were found, limited by different follow-up strategies. CardioSEAL and Starflex seemed to have higher AF incidences in early and late onset with 4.5% and 4.2%, respectively. Conclusion Percutaneous PFO closure led to higher AF post-procedural incidence compared to the conservative strategy. Heterogeneity in surveillance and follow-up strategy limited the generalizability. Trial Registration Registered on PROSPERO (CRD42022359945). Graphical abstract

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Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: A prospective study

Cited by 7 publications

References 18 publications

Temporal alterations in P-wave electrocardiographic metrics post patent foramen ovale closure: a retrospective study

Temporal alterations in P-wave electrocardiographic metrics post patent foramen ovale closure: a retrospective study

Incidence of atrial fibrillation in cryptogenic stroke with patent foramen ovale closure: protocol for the prospective, observational PFO-AF study

New-onset atrial fibrillation after percutaneous patent foramen ovale closure: a meta-analysis

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