Long-term incidence and risk factors of atrial fibrillation after percutaneous patent foramen ovale occlusion: a retrospective cohort study.

BACKGROUND: Percutaneous patent foramen ovale (PFO) closure is an established intervention for secondary prevention of cryptogenic stroke. Increasing evidence indicates that the procedure is associated with a risk of new-onset atrial fibrillation (AF). This study aimed to describe the temporal distribution and clinical factors associated with new-onset AF following percutaneous PFO closure. METHODS: Patients aged ≥16 years undergoing percutaneous PFO closure between 1999 and 2021 at a tertiary care centre were retrospectively included. New-onset AF was identified through systematic review of electronic health records. Descriptives are presented as median with IQR. Time-to-event analysis was performed using cumulative incidence functions and Cox proportional hazards regression. RESULTS: Among 867 patients (median age 51 years (42-58), 47% female), PFO closure was performed for secondary stroke prevention in 86%. During a median follow-up of 11.7 years (6.3-16.8), new-onset AF occurred in 97 patients (11.2%), corresponding to an incidence rate of 1.0 per 100 patient-years. AF diagnoses clustered early after closure, with 26.8% occurring within the first 3 months. In multivariable analysis, higher age at closure (HR 1.05 per year; 95% CI 1.03 to 1.07), larger occluder device size (HR 1.09 per mm; 95% CI 1.03 to 1.16) and any moderate or severe valvular regurgitation (HR 3.70; 95% CI 1.65 to 8.33) were independently associated with new-onset AF. CONCLUSIONS: New-onset AF is common after PFO closure and shows early postprocedural clustering. Increasing age, larger occluder size and valvular regurgitation are independently associated with AF occurrence, underscoring the need for focused rhythm surveillance after closure.