Incidence of new-onset atrial fibrillation after transcatheter patent foramen ovale closure using 15 years of Ontario administrative health data

Laura Oliva; Ella Huszti; Ruth Hall; Lusine Abrahamyan; Eric Horlick

doi:10.1016/j.hrthm.2022.04.006

Incidence of new-onset atrial fibrillation after transcatheter patent foramen ovale closure using 15 years of Ontario administrative health data

Heart Rhythm. 2022 Sep;19(9):1414-1420. doi: 10.1016/j.hrthm.2022.04.006. Epub 2022 Apr 13.

Authors

Laura Oliva¹, Ella Huszti², Ruth Hall³, Lusine Abrahamyan⁴, Eric Horlick⁵

Affiliations

¹ Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.
² Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Biostatistics Research Unit (BRU), Toronto General Hospital Research Institute, UHN, Toronto, Ontario, Canada.
³ Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
⁴ Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, UHN, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, UHN, Toronto, Ontario, Canada.
⁵ Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, University Health Network (UHN), Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Canada. Electronic address: eric.horlick@uhn.ca.

PMID: 35429648
DOI: 10.1016/j.hrthm.2022.04.006

Abstract

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

Objective: The purpose of this study was 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. Poisson regression determined event rates of AF and secondary outcomes such as stroke and mortality per 1000 person-years. A multivariable Cox proportional hazards model identified predictors of new-onset AF following TC.

Results: Of 1533 patients, 96 (6.26%) developed new-onset AF following PFO closure, over average follow-up time of 8.2 years. Age >60 years (hazard ratio [HR] 2.82; 95% confidence interval [CI] 1.76-4.51; P <.001) and diabetes (HR 2.49; 95% CI 1.48-4.18; P <.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.

Keywords: Atrial fibrillation arrhythmia; Patent foramen ovale; Patent foramen ovale closure; Percutaneous transcatheter closure; Survival analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Atrial Fibrillation* / complications
Atrial Fibrillation* / etiology
Cardiac Catheterization / adverse effects
Foramen Ovale, Patent* / complications
Foramen Ovale, Patent* / epidemiology
Foramen Ovale, Patent* / surgery
Humans
Incidence
Middle Aged
Ontario / epidemiology
Retrospective Studies
Risk Factors
Secondary Prevention
Stroke* / epidemiology
Stroke* / etiology
Stroke* / prevention & control
Treatment Outcome