Reply: Supraventricular Arrhythmia: The Most Frequent Complication After PFO Closure

We thank Dr Apostolos and colleagues and Dr Fortuni and colleagues for their relevant comments on our study evaluating the incidence and timing of supraventricular arrhythmias (SA) following patent foramen ovale (PFO) percutaneous closure.1 The optimal management of post-PFO SA regarding oral anticoagulation (OAC) remains unknown. Because most patients undergoing contemporary PFO closure have a history of stroke and a CHA₂DS₂-VASc score >1, OAC should certainly be initiated following the current international recommendations, and we do not think like Dr Fortuni that PFO closure is “useless” because there is no real evidence to support OAC for the prevention of stroke in patient with PFO. Our data support the fact that most SA episodes following PFO are transient, occurring within the first 4 weeks of the procedures, and OAC prescription should be reconsidered on the long term after demonstrating stable sinus rhythm.

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