Author + information
- Received October 15, 2013
- Revision received March 31, 2014
- Accepted April 25, 2014
- Published online November 1, 2014.
- Kanhaiya L. Poddar, MD∗,
- Vijaiganesh Nagarajan, MD†,
- Amar Krishnaswamy, MD∗,
- Navkaranbir S. Bajaj, MD†,
- Meera Kumari, MBBS∗,
- Hazem Bdair, MD∗,
- Dhruv Modi, MD∗,
- Shikhar Agarwal, MD, MPH, CPH∗,
- Sachin S. Goel, MD∗,
- Akhil Parashar, MD†,
- E. Murat Tuzcu, MD∗ and
- Samir R. Kapadia, MD∗∗ ()
- ∗Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- †Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Reprint requests and correspondence:
Dr. Samir Kapadia, Cardiovascular Medicine, Cleveland Clinic Main Campus, 9500 Euclid Avenue, J2-3, Cleveland, Ohio 44195.
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.
- intracardiac defibrillator
- intracardiac device
- ischemic stroke
- patent foramen ovale
- transient ischemic attack/stroke
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 15, 2013.
- Revision received March 31, 2014.
- Accepted April 25, 2014.
- American College of Cardiology Foundation