Determinants of Late Supraventricular Arrhythmia After Patent Foramen Ovale Closure: Insights From a Prospective Cohort

Background Early (≤ 28 days) supraventricular arrhythmia (SVA) is the most common complication that occurs after patent foramen ovale (PFO) closure, but little is known about the incidence and determinants of late (> 28 days) SVA. Our aim was to evaluate the determinants of late SVA after PFO closure. Methods Patients with percutaneous PFO closure and risk of SVA were proposed to receive an implantable loop recorder (ILR) device from 2019 to 2023. All rhythmic events recorded on ILR were adjudicated by cardiac electrophysiologists. Primary outcome was any late SVA, either new onset or recurrence, defined as SVA occurring > 28 days after PFO closure and lasting ≥ 30 seconds. Determinants were analyzed using a multivariable Cox proportional hazards model. Results Overall, 234 patients were included with a median duration of ILR rhythm monitoring of 21.6 (interquartile range, 15.5-30.6) months. An SVA after 28 days was recorded in 50 of 234 patients (2-year Kaplan-Meier estimate, 0.22 [0.16-0.27]), which were recurrent events in 29 of 50 (58.0%) cases and new-onset episodes in 21 of 50 (42.0%) cases. Incidence of new onset of SVA decreased significantly over time. In the multivariate analysis, determinants of late SVA were the early SVA burden (adjusted hazard ratio [aHR], 1.008; 95% confidence interval [CI], 1.003-1.013 per hour of SVA occurring in the first 28 days), male sex (aHR, 2.29; 95% CI, 1.19-4.42), and large left disc diameter (aHR, 2.50; 95% CI, 1.32-4.72). Conclusions Determinants of late SVA after PFO closure were SVA burden during the first month, male sex and large left disc diameter.