PhD Scientific Days 2022

Clinical Medicine II.

Complications in the PFO-closure program of the Neurocardiology group at the Heart and Vascular Centre of Semmelweis University

Text of the abstract

Introduction: PFO-closure is an effective intervention for secondary prevention of related ischaemic strokes. Our centre has been performing closures since 2018 with high success (94%) and low complication (3.0%) rates.
Aims: We aimed to asses and analyse the complications of the closures until January 2022.
Methods: We performed a retrospective clinical data analysis. Longer than 30 seconds of atrial fibrillation (AF) episodes were considered clinically relevant. The other complications were discovered using imaging techniques.
Results: We had 155 successful closures (94 %). Among the 5 complications, there were 3 AF-s, 1 device dislocation and 1 device thrombus. Only the intraoperative AF required electrical cardioversion. After it we monitored the patient with 30-day-Holter device, which did not detect any AF. We found two AF cases in the first postoperative month. In the first case, there was no recurrent arrhythmia, but the paroxysms of our other patient recurred despite antiarrhythmic drug treatment, therefore we plan ablation. All of these AF patients were administered oral anticoagulants (OAC). The device dislocation occurred in the
case of an atrial septal aneurysm, and the dislodged device did not cause any obstruction. It was removed percutaneously from the abdominal aorta, and we implanted a new device during the same session. Intraoperative transoesophageal echocardiography (TEE) identified in another case a non-symptomatic thrombus on the device, so we intensified the intraoperative heparin treatment, and indicated OAC for one month. Control TEE described normal device status.
Conclusion: Similarly to the multicentre studies, we also confirm, that the PFO-closure is safe with low complication rate. We could conclude, that it is important to select the most appropriate device. The long-term clinical relevance of triggered AF is doubted, so the treatment is not clearly defined yet. We have to find imaging markers in the future to predict its occurrence.
Funding: Non declared.