Key result
Predictive score identifies a highest-risk quartile with ~3-fold greater SVA rate after PFO closure.
Why the study?
Supraventricular arrhythmia is the most frequent complication after percutaneous patent foramen ovale closure, motivating the development and validation of a predictive score.
Can a predictive score identify patients at high risk of developing supraventricular arrhythmia after percutaneous patent foramen ovale closure?
Observational (n=2,553)
Yes
Can a predictive score identify patients at high risk of developing supraventricular arrhythmia after percutaneous patent foramen ovale closure?
A novel predictive score using clinical, anatomical, and device parameters can effectively identify patients at high risk for supraventricular arrhythmia after PFO closure, potentially guiding targeted rhythm monitoring strategies.
May guide targeted monitoring after PFO closure; leaves open external validation and outcome impact.
Background Supraventricular arrhythmia (SVA) is the most frequent complication after patent foramen ovale (PFO) percutaneous closure. Objectives To develop and validate a predictive score for SVA after PFO closure. Methods Patients with PFO closure and implantable loop recorder (ILR) monitoring were recruited in 15 French centers. Primary outcome was any SVA lasting ≥ 30 seconds within 3 months after procedure. The score was derived from multivariate logistic regression from a training set of patients, and then first tested in an independent internal validation set. Secondly, we performed an external validation in patients without ILR monitoring from centres of the AIR FORCE registry. Results Overall, 338 patients were included (270 in the training set - 68 in the internal validation set). Determinants of the prognostic score were age, sex, RoPE score, septum secundum thickness, left atrial volume and device left disc diameter. In the internal validation set, the Area Under the Curve (AUC) was 0.72 [0.58-0.87]. A threshold of 55 (fourth quartile of the training population score) had a specificity of 93.3% and a positive predicted value of 72.7%. The external validation in 2215 patients with clinical follow-up demonstrated a similar correlation with an observed three-fold increase in symptomatic SVA rate between the first and fourth quartiles. Conclusions A readily calculable score enables the identification of patients at high-risk of developing SVA after PFO closure patients and could help identify candidates for a specific rhythm monitoring strategy.
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Giovachini et al. (2025) conducted an observational in Patent Foramen Ovale (n=2,553). Predictive score for supraventricular arrhythmia was evaluated on any SVA lasting ≥ 30 seconds within 3 months after procedure (AUC 0.72, 95% CI 0.58-0.87). A predictive score for supraventricular arrhythmia after patent foramen ovale closure demonstrated an AUC of 0.72 (95% CI 0.58-0.87) in internal validation.
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