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

Florence Leclercq (1) , Xavier Odorico (1) , Gregory Marin (1) , Jean Christophe Macia (1) , Delphine Delseny (1) , Audrey Agullo (1) , Laurence Pages (1) , Pierre Robert (1, 2) , Benoit Lattuca (3) , Guillaume Cayla (3) , François Roubille (4, 1) , Nicolas Gaillard (1) , Caroline Arquizan (1) , Mariama Akodad (4, 1, 5)

1 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
2 CEFE - Centre d’Ecologie Fonctionnelle et Evolutive
3 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
4 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
5 IGF - Institut de Génomique Fonctionnelle

Background: Increased risk of new-onset atrial fibrillation (AF) after patent foramen ovale (PFO) closure was observed in randomized trials without however systematic AF screening. We aimed to evaluate the incidence of AF within 6-month following PFO closure with serial 24-hour ambulatory electrocardiogram (AECG) monitoring. Methods: All patients undergoing PFO closure were prospectively included in 2 centers. AF was defined as irregular rhythm without discernible P waves > 30 s on AECG at day 0, 1-month and 6-month follow-up. Primary endpoint was the incidence of AF within the study period. Secondary endpoints evaluated clinical outcomes within 6-month follow-up. Results: Between February 2018 and March 2019, 62 patients underwent PFO closure including 40 male (64.5%) with a mean age of 48 ± 9.5. Atrial septal aneurysm was observed in 37 patients (64.9%), 57 patients (91.9%) received an Amplatzer Occluder device (Abbott Vascular) and 5 (8.1%) an Occlutech device (Occlutech). After a mean follow-up of 7.7 ± 2.8 months, new-onset AF occurred in 3 patients (4.8%), all within the first month following PFO closure, including one per-procedural, all were asymptomatic and paroxysmal. Two patients with AF (3.2%) required chronic oral anticoagulant therapy. No adverse outcomes occurred at follow-up. No predictive factors of AF were highlighted. A total of 16 patients (25.8%) reported palpitations without AF on the AECGs. onclusion: In highly selected patients, incidence of AF, evaluated with 3 systematic 24-hour AECG within 6-month following PFO closure, was low (<5%). Always paroxysmal, AF occurred within the first month after the procedure and was not associated with adverse outcomes.

Mots clés: Atrial fibrillation; Holter Monitoring; Patent foramen ovale; Percutaneous closure

Domaines: Cardiologie et système cardiovasculaire

Florence Leclercq, Xavier Odorico, Gregory Marin, Jean Christophe Macia, Delphine Delseny, et al.. Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: A prospective study. International Journal of Cardiology. Heart & Vasculature, 2021, 37, pp.100919. ⟨10.1016/j.ijcha.2021.100919⟩. ⟨hal-03470879v2⟩