Risk of cerebrovascular events in patients with patent foramen ovale and intracardiac devices.

Abstract

OBJECTIVES:

This study investigated whether patients with patent foramen ovale (PFO) have an increased risk of stroke due to permanent pacemaker (PPM)/implantable cardioverter-defibrillator (ICD) implantation.

BACKGROUND:

Data are lacking on the risk of stroke in patients with PFO and implantable intracardiac devices, either a PPM or an ICD. We investigated whether patients with PFO have increased risk of stroke due to PPM/ICD implantation.

METHODS:

Between 2001 and 2008, 2,921 consecutive patients with PFO (67.5 ± 16.4 years of age, 52.2% male) were identified from our echocardiography database. These patients were divided into a device group (patients had PPM/ICD implantation for any reason after receiving a diagnosis of PFO) and a no device group (patients did not have PPM or ICD implantation). Patients who had PFO closure during follow-up were excluded. Both groups were matched for baseline characteristics and medications. The incidence of ischemic stroke was assessed in each group after propensity score matching (case:control ratio of 1:1 yielding 231 pairs). All patients completed at least 4 years of follow-up until May 2012.

RESULTS:

There were 2,690 patients in the n device group (67.3 ± 16.4 years of age, 51.6% male) and 231 patients in the device group (75.4 ± 14.6 years of age, 59.3% male). Six patients (2.6%) in the no device group and 6 (2.6%) in the device group had a stroke during the follow-up period. No difference in the rate of stroke, transient ischemic stroke, or stroke/transient ischemic stroke was observed between the 2 groups.

CONCLUSIONS:

The risk of stroke in patients with PFO and an implantable intracardiac device is similar to those without an intracardiac device. In patients with PFO, without a history of stroke, device implantation might not be considered a risk factor for future stroke occurrence.

• Authors: Kanhaiya L Poddar, Vijaiganesh Nagarajan, Amar Krishnaswamy, Navkaranbir S Bajaj, Meera Kumari, Hazem Bdair, Dhruv Modi, Shikhar Agarwal, Sachin S Goel, Akhil Parashar, E Murat Tuzcu, Samir R Kapadia
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 7 Issue 11 Pg. 1221-6 (Nov 2014) ISSN: 1876-7605 [Electronic] United States
• PMID: 25326741 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Brain Ischemia (diagnosis, epidemiology)
• Cardiac Pacing, Artificial (adverse effects)
• Comorbidity
• Databases, Factual
• Defibrillators, Implantable (adverse effects)
• Electric Countershock (adverse effects, instrumentation)
• Female
• Foramen Ovale, Patent (diagnosis, epidemiology)
• Humans
• Incidence
• Male
• Middle Aged
• Ohio (epidemiology)
• Pacemaker, Artificial (adverse effects)
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Stroke (diagnosis, epidemiology)
• Time Factors