Long-term incidence of first hospital-recorded atrial arrhythmias and all-cause mortality after percutaneous patent foramen ovale closure: a single-centre cohort linked to Czech nationwide administrative health data

Figures

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  Figure 1. Derivation of the study cohort and outcomes. Flow of participants from all percutaneous PFO closure procedures performed between 2010 and 2024 to the analytical cohort and the three study outcomes. Repeat procedures in the same patient contributed once to patient-level analyses. Patients with previously documented atrial arrhythmia were not referred for closure and were therefore excluded at the referral stage rather than from the linked dataset.

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  Figure 2. Cohort characteristics and procedural volume. (A) Number of procedures: annual number of percutaneous PFO closures between 2010 and 2024. (B) Age and sex distribution of the study cohort. Sex percentages are calculated among patients with documented sex (n = 692); sex was undocumented in 15 patients.

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  Figure 3. Temporal trends in cardiovascular comorbidity prevalence among patients undergoing percutaneous PFO closure between 2010 and 2024. (A) Prevalence of diabetes mellitus, defined by ICD-10 codes E10–E14 and/or dispensing of antidiabetic medication (ATC group A10). (B) Prevalence of arterial hypertension, defined by ICD-10 code I10 and/or dispensing of antihypertensive medication (ATC groups C02, C03, C07–C09). (C) Prevalence of hyperlipidaemia, operationally defined by dispensing of lipid-modifying therapy (selected ATC C10 codes) in the year of PFO closure or earlier. Three-panel figure demonstrating annual prevalence trends of diabetes mellitus, arterial hypertension and hyperlipidaemia among patients undergoing percutaneous patent foramen ovale closure between 2010 and 2024.

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  Figure 4. Cumulative incidence of first hospital-recorded atrial arrhythmia after percutaneous PFO closure. (A) Kaplan–Meier cumulative incidence, with numbers at risk shown beneath the x-axis. (B) Fine–Gray cumulative incidence function accounting for death as a competing event. Cumulative incidence functions estimated using the Fine–Gray competing-risks model in the full study cohort (n = 707), showing atrial arrhythmia (event of interest) and death (competing event); shaded areas represent 95% confidence intervals. Patients were followed from the date of percutaneous PFO closure until the occurrence of atrial arrhythmia, death, or the end of follow-up on 31 December 2024.

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  Figure 5. Kaplan–Meier cumulative incidence of catheter ablation following percutaneous PFO closure. Cumulative incidence of catheter ablation for atrial tachyarrhythmia after PFO closure in the study cohort (n = 707). Time-to-event analysis was performed using the Kaplan–Meier method. Follow-up was calculated from the date of percutaneous PFO closure to the date of first catheter ablation. Patients without a recorded ablation procedure were censored at the date of death or on 31 December 2024.

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  Figure 6. Long-term survival following percutaneous PFO closure. (A) Observed cumulative all-cause mortality estimated using the Kaplan–Meier method. (B) Net survival relative to the contemporaneous Czech general population estimated using the Pohar–Perme method. Survival analyses were performed in the full study cohort (n = 707). For Kaplan–Meier analysis, patients were followed from the date of percutaneous PFO closure until death or administrative censoring on 31 December 2024. Net survival was estimated using the Pohar–Perme method with age-, sex- and calendar year-matched Czech population life tables.

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  Figure 7. Distribution of causes of death according to ICD-10 chapter classification. Cause-specific mortality among patients undergoing percutaneous PFO closure between 2010 and 2024 (n = 34 deaths). Causes of death were classified according to ICD-10 chapter categories derived from the Czech Statistical Office mortality database.