Patent foramen ovale and left atrial appendage flow velocity predict atrial fibrillation recurrence post cryoballoon ablation

Abstract

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The intriguing association between patent foramen ovale and atrial fibrillation

“…The association between increased left atrial size and AF recurrence post-ablation has been welldocumented in previous studies [2]. In line with the findings of the study of Kiełbasa et al [1], reduced left atrial appendage velocity has been found to be associated with increased risk of AF after cardiac surgery [3]. In our view, the most intriguing finding of this study is the 79% increased risk of AF recurrence associated with the presence of a PFO.…”

“…The study by Kiełbasa et al [1] provides additional evidence on the intriguing association between PFO and AF with a novel perspective that requires further testing in independent cohorts.…”

“…Although these mechanisms are plausible, they are likely influenced by other factors. First, as suggested by the frequent coexistence of paroxysmal AF and PFO in the study of Kiełbasa et al [1], AF may constitute a latent subclinical condition in patients with PFO that becomes more active and clinically evident after the PFO is closed. In this hypothetical scenario, a PFO closure may lower the threshold for the occurrence of AF paroxysms in patients with otherwise relatively inactive and subclinical AF.…”

“…Since a PFO is present in ~25% of the population [9], it is surprising that Kielbasa et al [1] found a PFO in only 12.7% of their patients, relying on TEE for diagnosis. Daher et al [5] reported that among AF patients referred for PVI, 57% had a PFO identified by catheter probing, but only 18.7% of patients had a PFO diagnosed by TEE.…”

“…The embolic risk of PFOs that are visualized only by catheter probing is likely low, although it has never been investigated. Alternatively, it is also possible that the PFO itself generates some degree of atrial vulnerability [11], creating the necessary physiological environment for the occurrence of AF, as mentioned by Kiełbasa et al [1].…”