Incidence of new onset atrial fibrillation after transcatheter PFO closure using 15 years of Ontario administrative health data

Background — Individuals with patent foramen ovale (PFO) routinely undergo transcatheter closure (TC) for secondary prevention of recurrent stroke. However, there has been some evidence suggesting that TC may increase the risk of new-onset atrial fibrillation (AF).

Objective — To evaluate the risk of new-onset AF following PFO closure and to explore predictors of AF development.

Methods — We created a retrospective cohort of all Ontarians over 18-years of age who received TC between October 2002 and December 2017 using administrative health data and the CorHealth cardiac registry. A Poisson regression determined event rates of AF and secondary outcomes such as stroke and mortality per 1,000 person-years. A multivariable Cox proportional hazards model identified predictors of new-onset AF following TC.

Results — Of 1,533 patients, 96 (6.26%) developed new-onset AF following PFO closure, over an average follow-up time of 8.2 years. Age >60 years (HR =2.82; CI:1,76-4.51; p < 0.001) and diabetes (HR=2.49; CI:1.48-4.18; p <0.001) were statistically significant, independent predictors of AF according to the Cox model.

Conclusions — The incidence of new-onset AF after PFO closure was relatively low. Having diabetes and age > 60 years were the most important factors associated with new-onset AF in this population.