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Insertable cardiac monitor detection of silent atrial fibrillation in candidates for percutaneous patent foramen ovale closure.
- Source :
-
Journal of cardiovascular medicine (Hagerstown, Md.) [J Cardiovasc Med (Hagerstown)] 2019 May; Vol. 20 (5), pp. 290-296. - Publication Year :
- 2019
-
Abstract
- Aim: An underlying atrial vulnerability or a preexisting misdiagnosed atrial fibrillation in some patients who are candidates for patent foramen ovale (PFO) closure may lead to an unnecessary percutaneous intervention. The aim of this work was to define paroxysmal atrial fibrillation rate, through a 6-month insertable loop-recorder monitoring, in patients over 55 years old with cryptogenic stroke and PFO.<br />Methods: PFO closure criteria: significant right-to-left shunt and at least one high-risk feature (permanent right-to-left shunt, atrial septal aneurysm, prominent Eustachian valve, recurrent brain ischemia, previous deep vein thrombosis, thrombophilia). Insertable cardiac monitoring criteria: previous cryptogenic stroke, more than 55 years and at least one atrial fibrillation risk factor (heart failure, hypertension, age older than 65 years, diabetes, atrial runs, left atrium dilatation, left ventricle hypertrophy, pulmonary disease, thyroid disease, obesity). Atrial fibrillation detection threshold: arrhythmia duration longer than 5 min.<br />Results: From January 2008 to March 2017, 195 patients underwent to loop-recorder monitoring. A total of 70 (36%) patients were candidates for PFO closure. The 6-month silent atrial fibrillation rate was 11.4%. In the arrhythmia-free cohort, 28 patients (45.2%) underwent percutaneous foramen ovale closure (group A) and 34 (54.8%) were medically treated (group B). Atrial fibrillation detection rate was 14.3% in group A and 0% in group B. The 36-month atrial fibrillation-free survival was 76%.<br />Conclusion: An occult preexisting atrial fibrillation may lead to unnecessary percutaneous foramen ovale closure in a significant proportion of patients. A 6-month loop-recorder monitoring may improve the patient oriented decision-making.
- Subjects :
- Aged
Asymptomatic Diseases
Atrial Fibrillation complications
Atrial Fibrillation physiopathology
Clinical Decision-Making
Female
Foramen Ovale, Patent complications
Foramen Ovale, Patent diagnostic imaging
Humans
Male
Middle Aged
Patient Selection
Predictive Value of Tests
Progression-Free Survival
Prospective Studies
Risk Factors
Stroke diagnosis
Stroke etiology
Time Factors
Treatment Outcome
Atrial Fibrillation diagnosis
Cardiac Catheterization
Electrocardiography instrumentation
Foramen Ovale, Patent therapy
Heart Rate
Stroke prevention & control
Telemetry instrumentation
Unnecessary Procedures
Subjects
Details
- Language :
- English
- ISSN :
- 1558-2035
- Volume :
- 20
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of cardiovascular medicine (Hagerstown, Md.)
- Publication Type :
- Academic Journal
- Accession number :
- 30921267
- Full Text :
- https://doi.org/10.2459/JCM.0000000000000790