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Abstract WP259: Risk of Atrial Fibrillation in Patients With Patent Foramen Ovale: A Meta-Analysis


 Background:
 Case-control studies have shown that patent foramen ovale (PFO) is strongly associated with ischaemic stroke, especially in younger patients and embolic stroke of undetermined source. A commonly encountered clinical question is whether undetected atrial fibrillation (AF) is the alternate cause for embolic stroke in such patents.
 
 
 Aim:
 This study aims to evaluate the risk of AF in patients with PFO, and explore clinical factors that might predict detection of AF in this population.
 
 
 Methods:
 Studies were identified by systematically searching EMBASE and MEDLINE databases on 11
 th
 July, 2019. The primary outcome was the risk of atrial fibrillation in patients with PFO compared with those who did not. Outcomes were pooled using a random-effects model using the method of DerSimonian &Laird. Methods used for AF detection in included studies (unspecified, history/medical records review, ECG, Holter monitor, or loop recorder) were noted.
 
 
 Results:
 A total of 12 studies and 12,764 patients were included. The average age was 63.2 years and 39.1% were female. There was a reduced risk of AF detection in patients with PFO compared to those without (OR 0.471, 95% confidence interval, 0.313-0.630, p<0.001). There was evidence of moderate heterogeneity. Univariable random-effects meta-regression by mean patient age, prevalence of hypertension and diabetes, and method of AF detection did not detect an association with risk of AF. Meta-regression by PFO detection technique suggested that studies using transoesophageal echocardiogram for PFO detection reported higher risk of AF(1.48, 95% confidence interval 1.15-1.91, p=0.006).
 
 
 Conclusion:
 The presence of PFO in patients with ischaemic stroke/TIA is associated with lower risk of AF detection compared to those without PFO.
