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The presence of a large patent foramen ovale reduces acute and chronic success in atrial fibrillation ablation

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Abstract

Purpose

In this study, we analyzed PFO implications in atrial fibrillation (AF) ablation.

Methods

Six hundred and twenty-five consecutive patients with AF undergoing PV isolation were included. We considered that a large and/or compliant PFO was present if the catheters advanced gently into the LA without puncturing the septum. Atrial tachyarrhythmias after the 3-month blanking period were classified as a recurrence.

Results

Out of the 625 patients included, 36 (5.8%) were found to have PFO. No significant differences were observed in the clinical characteristics of patients with PFO compared with patients without PFO. Nevertheless, patients with PFO had lower acute success in PV isolation compared with patients without PFO (98.2% vs. 88.5%; p = 0.006) even after adjusting for age, sex, type of AF, LA area, cardiomyopathy, time from AF diagnosis to the ablation, and ablation technique (odds ratio: 0.1; 95% confidence interval (CI): 0.02–0.9; p = 0.039). In 546 patients followed more than 6 months, the recurrence rate of any atrial tachyarrhythmia after 18.6 ± 11.9 months was significantly higher in patients with PFO compared with patients without PFO (41.9 vs. 70%; p = 0.012). This difference remained significant after adjusting for age, sex, type of AF, LA area, cardiomyopathy, time from AF diagnosis to the ablation, and ablation technique (hazard ratio: 1.9; 95% CI: 1.1–3.3; p = 0.015).

Conclusions

The presence of a large and/or compliant PFO is an independent factor for PV isolation failure and arrhythmia recurrence rate after the ablation.

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Data availability

We declare that the data of this study are available for any request.

Code availability

Not applicable

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Funding

This work is funded by the Spanish Government Official Agency for funding biomedical research-Instituto de Salud Carlos III (ISCIII), with competitive grants through the Fondo de Investigación Sanitaria y Fondo Europeo de Desarrollo Regional (PI17/00718, PI17/ 00748, PI17/01870), and the Spanish Society of Cardiology (FEC/ 2017).

Author information

Authors and Affiliations

  1. Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain

    Maria Teresa Barrio-Lopez, Eduardo Castellanos, Andres Betancur, Nieves Losada, Maria Diaz del Valle, Cristina Sanchez, Rosa Crespo, Victor Gonzalez, Tamara Morales, Belen Urriza, Mercedes Ortiz & Jesús Almendral

  2. Department of Cardiology, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain

    Blanca Zorita & Juan Medina

Authors
  1. Maria Teresa Barrio-Lopez
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  2. Eduardo Castellanos
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  3. Andres Betancur
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  4. Blanca Zorita
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  5. Juan Medina
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  6. Nieves Losada
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  7. Maria Diaz del Valle
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  8. Cristina Sanchez
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  9. Rosa Crespo
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  10. Victor Gonzalez
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  11. Tamara Morales
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  12. Belen Urriza
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  13. Mercedes Ortiz
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  14. Jesús Almendral
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Corresponding author

Correspondence to Maria Teresa Barrio-Lopez.

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Ethics approval

This study was approved by the Hospital Ethics Committee.

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Given the retrospective nature of the study, it was not considered compulsory to obtain a specific informed consent.

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All authors have given their consent to publish this manuscript.

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The authors declare no competing interests.

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Barrio-Lopez, M.T., Castellanos, E., Betancur, A. et al. The presence of a large patent foramen ovale reduces acute and chronic success in atrial fibrillation ablation. J Interv Card Electrophysiol 64, 705–713 (2022). https://doi.org/10.1007/s10840-022-01134-y

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  • DOI: https://doi.org/10.1007/s10840-022-01134-y

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