Abstract 17868: Effect of Device Implantation on Stroke Outcomes in Patients with Patent Foramen Ovale
Background: Data are lacking on the risk of stroke in patients with patent foramen ovale (PFO) and implantable intracardiac devices, either permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD).
Aim: To investigate whether patients with PPM or ICD have increased risk of stroke in the presence of PFO.
Methods: Between 2001 and 2008, 3056 consecutive adult patients (> 18 years of age) with PFO were identified from our echocardiography database. These patients were divided into ‘Device group’, where patients had pacemaker/ICD implantation for any reason after being diagnosed with PFO and ‘No device group’, where patients did not have pacemaker or ICD implantation. Patients who had PFO closure during follow up were excluded. Both the groups were matched for age, gender, hypertension, diabetes mellitus, aortic stenosis, mitral regurgitation, ejection fraction and atrial fibrillation. Stroke risk was assessed in each group after propensity matching (case: control ration of 1:1 yielding 234 pairs). All patients completed at least 4 years of follow up till May 2012.
Results: A total of 3056 PFO patients were identified (age 67.5 ± 16.4 years, male 52.2%). There were 2822 patients in ‘No device group’ (age 66.8 ± 16.4, male 51.7%) and 234 patients in ‘Device group’ (age 75.5 ± 14.6, male 59.0%). Baseline characteristics before and after propensity matching is shown in Table. Thirty eight patients (16.2%) in ‘no device group’ and twenty eight patients (12.0%) in ‘device group’ had stroke during follow up period. No difference in the rate of stroke was observed between the two groups after multivariate analysis (adjusted odds ratio, 0.65; 95% confidence interval, 0.36 to 1.16; P=0.14).
Conclusion: The risk of stroke in patients with PFO and implantable intracardiac device is similar to those without an intracardiac device. In patients with PFO, device implantation might not be considered as a risk factor for future stroke occurrences.
- © 2012 by American Heart Association, Inc.