Mid-term Electrical Remodelling in Surface ECG Following Percutaneous Patent Foramen Ovale Closure

Background: Controversy exists around AF risk after patent foramen ovale (PFO) closure. This study characterised dynamic ECG changes over 6 months after Amplatzer closure, focusing on electrical remodelling. Methods: In all, 246 PFO patients underwent serial ECGs (P wave dispersion [PWD], PR interval, QRS, corrected QT interval [QTc]) and echocardiography before PFO closure and 24 hours and 1, 3 and 6 months after closure. Temporal changes were analysed. Subgroup analyses evaluated ECG changes according to comorbidity (migraine or cerebral infarction). Results: PWD increased significantly at 24 hours and peaked at 1 month, remaining elevated compared with baseline at 6 months (p<0.001). Of all patients, 5.3% had PWD ≥40 ms. The PR interval was significantly shortened after PFO closure, with this persisting at 6 months (p<0.001). AF occurred in six (2.4%) patients and supraventricular tachycardia occurred in eight (3.3%). QRS and QTc were stable. With regard to cardiac structure/function, no significant echocardiographic changes were seen from before to after PFO closure. In subgroups analyses, PR shortening was greater in patients with migraine than in those with cerebral infarction (p<0.001). Conclusion: PFO closure induced a transient elevation in PWD and sustained PR shortening. Under limited spot ECG monitoring, no clinically significant arrhythmias or structural changes were detected. However, extended surveillance is warranted to evaluate potential late-onset arrhythmogenic sequelae.