Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence
Authors: Gaurav Aggarwal, Saurabh Aggarwal, Marc Cohen
Journal: Annals of Internal Medicine (2020)

Letters1 December 2020Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke RecurrenceGaurav Aggarwal, MD, Saurabh Aggarwal, MD, and Marc Cohen, MDGaurav Aggarwal, MDJersey City Medical Center, Jersey City, New Jersey (G.A.)Search for more papers by this author, Saurabh Aggarwal, MDUnityPoint Clinic, Des Moines, Iowa (S.A.)Search for more papers by this author, and Marc Cohen, MDNewark Beth Israel Medical Center, Newark, New Jersey (M.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1269 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Deng and colleagues (1) prospectively followed 1078 patients with PFO-attributed cryptogenic stroke who had percutaneous PFO closure. Approximately 0.5% of these patients were subsequently diagnosed with atrial fibrillation (AF). We would like to highlight the complex interplay between AF and PFO.Baseline PFO has been associated with 3.5-fold increased odds of future AF, possibly because of related left atrial dyssynchrony and stiffness. Closure of PFO itself has been associated with increased risk for AF in many studies, which may be associated with atrial vulnerability and device-related atrial irritation (2). Conversely, in a recent study, PFO was found ...References1. Deng W, Yin S, McMullin D, et al. Residual shunt after patent foramen ovale closure and long-term stroke recurrence. A prospective cohort study. Ann Intern Med. 2020;172:717-25. doi:10.7326/M19-3583 LinkGoogle Scholar2. Garg A, Thawabi M, Rout A, et al. Recurrent stroke reduction with patent foramen ovale closure versus medical therapy based on patent foramen ovale characteristics: a meta-analysis of randomized controlled trials. Cardiology. 2019;144:40-9. [PMID: 31574522] doi:10.1159/000500501 CrossrefMedlineGoogle Scholar3. Daher G, Hassanieh I, Malhotra N, et al. Patent foramen ovale prevalence in atrial fibrillation patients and its clinical significance; a single center experience. Int J Cardiol. 2020;300:165-7. [PMID: 31761403] CrossrefMedlineGoogle Scholar4. Tarantini G, D'Amico G, Baracchini C, et al. [Position paper of the Italian Society of Interventional Cardiology (SICI-GISE): management of patent foramen ovale in patients with cerebral or systemic thromboembolism—2020]. G Ital Cardiol (Rome). 2020;21:50S-9S. [PMID: 32250371] MedlineGoogle Scholar5. Elmariah S, Furlan AJ, Reisman M, et al; CLOSURE I Investigators. Predictors of recurrent events in patients with cryptogenic stroke and patent foramen ovale within the CLOSURE I (Evaluation of the STARFlex septal closure system in patients with a stroke and/or transient ischemic attack due to presumed paradoxical embolism through a patent foramen ovale) trial. JACC Cardiovasc Interv. 2014;7:913-20. [PMID: 25147037] doi:10.1016/j.jcin.2014.01.170 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Jersey City Medical Center, Jersey City, New Jersey (G.A.)UnityPoint Clinic, Des Moines, Iowa (S.A.)Newark Beth Israel Medical Center, Newark, New Jersey (M.C.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1269. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoResidual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence Wenjun Deng , Shanye Yin , David McMullin , Ignacio Inglessis-Azuaje , Sammy Elmariah , Judy Hung , Eng H. Lo , Igor F. Palacios , Ferdinando S. Buonanno , and MingMing Ning Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence Preetham Kumar , Mohammad K. Mojadidi , and Jonathan M. Tobis Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence Alexia Karagianni , Peter Eriksson , and Mikael Dellborg Residual Shunt After Patent Foramen Ovale Closure and Long-Term Stroke Recurrence Wenjun Deng , Shanye Yin , David McMullin , Ignacio Inglessis-Azuaje , Sammy Elmariah , Judy Hung , Eng H. Lo , Igor F. Palacios , Ferdinando S. Buonanno , and MingMing Ning Metrics Cited byFive Year Follow-Up of Cryptogenic Stroke Patients Following Patent Foramen Ovale Closure 1 December 2020Volume 173, Issue 11Page: 945KeywordsAtrial fibrillationCathetersConflicts of interestDisclosureForecastingStiffnessStrokeTransient ischemic attacks ePublished: 1 December 2020 Issue Published: 1 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...