{"id":"b99ab4bae3eb","type":"article","url":"https://hartvaat.nl/2026/09/01/pre-existent-pfo-of-asd-verhoogt-risico-op-recidief-en-stroke-na-ablatie-bij-atr/","title":"Pre-existent PFO of ASD verhoogt risico op recidief en stroke na ablatie bij atriumfibrilleren","title_en":"Patients With Patent Foramen Ovale or Atrial Septal Defect Have Worse Outcomes After Pulmonary Vein Isolation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"The American journal of cardiology","doi":"10.1016/j.amjcard.2026.06.030","source_url":"https://doi.org/10.1016/j.amjcard.2026.06.030","authors":["Suraj S Patel","Sakshum Chadha","Sandi Bajrami","Thomas P Fedrigoni","David T Zhang"],"significance":5,"published":"2026-08-19","source_date":"2026-09-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/"],"congress":"","summary_en":"A propensity-matched cohort study using TriNetX claims data compared outcomes in 2,804 patients with a pre-existing PFO or ASD versus 2,804 without these defects following pulmonary vein isolation for atrial fibrillation. Over two years, patients with a septal defect had significantly higher rates of hospitalization (HR 1.14), direct-current cardioversion (HR 1.18), antiarrhythmic drug use (HR 1.12), and stroke (HR 1.36), with no difference in mortality or redo ablation. These real-world findings suggest that EP specialists should counsel patients with PFO or ASD about their elevated risk of arrhythmia recurrence and stroke following catheter ablation.","created":"2026-08-13T01:12:35Z","updated":"2026-08-13T01:12:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een retrospectieve cohortstudie met TriNetX-data vergeleek 2.804 patiënten met een pre-existent PFO of ASD met evenveel patiënten zonder deze defecten na pulmonale vene-isolatie (PVI) voor atriumfibrilleren. Patiënten met een septumdefect hadden een hoger risico op ziekenhuisopname (HR 1,14), elektrische cardioversie (HR 1,18), gebruik van hartritme-remmers (HR 1,12) en stroke (HR 1,36) over twee jaar, terwijl mortaliteit en her-ablatie niet verschilden. Deze bevindingen suggereren dat cardiologen patiënten met een PFO of ASD extra moeten voorlichten over het verhoogde risico op recidief en complicaties na ablatie.","abstract_original":"Patients with patent foramen ovale (PFO) and atrial septal defect (ASD) have increased rates of atrial fibrillation (AF) because of chronic atrial stretch and remodeling. However, the impact of these defects on outcomes after pulmonary vein isolation (PVI) remains unknown. This study aimed to determine whether preexisting PFO or ASD is associated with worse clinical outcomes following PVI. Using TriNetX, a global research network of over 130 million patients, we identified adults undergoing PVI via Current Procedural Terminology codes through November 2022. Patients with a preexisting PFO or ASD were compared with those without using propensity score matching (PSM). Outcomes included mortality, hospitalization, redo ablation, direct-current cardioversion (DCCV), antiarrhythmic drug (AAD) use, and stroke over 2 years of follow-up. We examined a total of 53 healthcare organizations and 81,442 patients without a PFO or ASD and 2,884 patients with one. After applying propensity score matching, each cohort included 2,804 patients. The average age was 63.8 years, 35.3% of patients were female, and the average left ventricular ejection fraction was 52.9%. Patients with PFO or ASD had higher rates of hospitalization (34.9% vs 30.7%; HR 1.14, 95% CI 1.04 to 1.25), direct-current cardioversion (20.9% vs 17.6%; HR 1.18, 95% CI 1.05 to 1.33), antiarrhythmic drug use (57.8% vs 53.3%; HR 1.12, 95% CI 1.05 to 1.20), and stroke (7.0% vs 5.1%; HR 1.36, 95% CI 1.09 to 1.68; all p < 0.01). Mortality and redo ablation did not differ. In patients with atrial fibrillation undergoing PVI, preexisting PFO or ASD was associated with greater markers of recurrent arrhythmia, increased hospitalizations, and more strokes."}