Insertable cardiac monitor detection of silent atrial fibrillation in candidates for percutaneous patent foramen ovale closure
| Autor: | Marcella Jorfida, Fabrizio D'Ascenzo, Carla Giustetto, Christian Pristipino, Domenica Zema, Paolo Cerrato, Lorenza M Biava, Ilaria Meynet, Paolo Scacciatella, Fiorenzo Gaita |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Time Factors Percutaneous Deep vein medicine.medical_treatment Clinical Decision-Making Foramen Ovale Patent Unnecessary Procedures 030204 cardiovascular system & hematology Electrocardiography 03 medical and health sciences 0302 clinical medicine Heart Rate Predictive Value of Tests Risk Factors Internal medicine Atrial Fibrillation Humans Telemetry Medicine Prospective Studies cardiovascular diseases 030212 general & internal medicine Aged Cardiac catheterization business.industry Patient Selection Atrial fibrillation General Medicine Middle Aged medicine.disease Thrombosis cryptogenic stroke – patent foramen ovale – internal cardiac monitor Progression-Free Survival Stroke Treatment Outcome medicine.anatomical_structure Heart failure Asymptomatic Diseases cardiovascular system Foramen ovale closure Patent foramen ovale Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiovascular Medicine. 20:290-296 |
| ISSN: | 1558-2027 |
| DOI: | 10.2459/jcm.0000000000000790 |
| Popis: | Aim An underlying atrial vulnerability or a preexisting misdiagnosed atrial fibrillation in some patients who are candidates for patent foramen ovale (PFO) closure may lead to an unnecessary percutaneous intervention. The aim of this work was to define paroxysmal atrial fibrillation rate, through a 6-month insertable loop-recorder monitoring, in patients over 55 years old with cryptogenic stroke and PFO. Methods PFO closure criteria: significant right-to-left shunt and at least one high-risk feature (permanent right-to-left shunt, atrial septal aneurysm, prominent Eustachian valve, recurrent brain ischemia, previous deep vein thrombosis, thrombophilia). Insertable cardiac monitoring criteria: previous cryptogenic stroke, more than 55 years and at least one atrial fibrillation risk factor (heart failure, hypertension, age older than 65 years, diabetes, atrial runs, left atrium dilatation, left ventricle hypertrophy, pulmonary disease, thyroid disease, obesity). Atrial fibrillation detection threshold: arrhythmia duration longer than 5 min. Results From January 2008 to March 2017, 195 patients underwent to loop-recorder monitoring. A total of 70 (36%) patients were candidates for PFO closure. The 6-month silent atrial fibrillation rate was 11.4%. In the arrhythmia-free cohort, 28 patients (45.2%) underwent percutaneous foramen ovale closure (group A) and 34 (54.8%) were medically treated (group B). Atrial fibrillation detection rate was 14.3% in group A and 0% in group B. The 36-month atrial fibrillation-free survival was 76%. Conclusion An occult preexisting atrial fibrillation may lead to unnecessary percutaneous foramen ovale closure in a significant proportion of patients. A 6-month loop-recorder monitoring may improve the patient oriented decision-making. |
| Databáze: | OpenAIRE |
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