Changes in left atrial function after percutaneous closure of patent foramen ovale

Abstract

Purpose This study aimed to investigate left atrial (LA) function following patent foramen ovale (PFO) closure.Methods Patients with PFO who underwent transcatheter closure between 2015 and 2022 and had complete echocardiography examination data available at baseline and at least twice during 1-year of follow-up were enrolled. LA function was evaluated by measuring LA reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct) through speckle-tracking echocardiography. Differences in LA strain between baseline and at the different follow-up times were compared using repeated-measures analysis. The association between risk factors and LA strain was evaluated in a univariable and multivariable linear regression model.Results Forty-five patients were included. After 3 months, we observed a decrease in LASr (from 40.98–33.09%, P < 0.05), which recovered to 37.30% at 6 months (P = 0.06). LAScd decreased significantly from baseline after the procedure (P < 0.05) but had recovered by 3 months (19.96% vs 19.04%, P = 0.06). LASct decreased significantly between baseline and 6 months (from 17.92–14.01%, P < 0.05). All changes resolved by 1 year. Multivariable models showed that LA strain at baseline was the most important factor affecting LA function. LA diameter was significantly associated with sustained changes in LAScd (β = 7.19, P = 0.038). Age was a risk factor for difficult recovery of LASct after PFO at 3 months.Conclusions Implantation of a PFO occluder has a transient adverse impact on LA function in the area adjacent to the device but resolves within 1 year.

Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management

“… 41 A recent report by Qiu supported that LA conduit and LA contraction strain were reduced significantly immediately and 6 months after the procedure, respectively. 42 Tarsia and colleagues showed that LA reservoir function, conduit function, and contractile function worsen after transcatheter PFO closure compared with patients treated with suture‐mediated PFO closure or healthy subjects. 43 Moreover, LA strain has been acknowledged as an imaging marker used for the prediction of new‐onset AF and AF recurrence.…”

“…However, both Vavouranakis and Qiu support that LA function recovers after 6 to 12 months following the procedure, which is compatible with the notion that AF is transient after PFO closure. 41 , 42 …”