Endocardial Device Leads in Patients with Patent Foramen Ovale: Echocardiographic Correlates of Stroke/TIA and Mortality

Shiva P. Ponamgi, Vaibhav R. Vaidya, Christopher V. Desimone, Amit Noheria, David O. Hodge, Joshua P. Slusser, Naser M. Ammash, Charles J. Bruce, Alejandro A. Rabinstein, Paul A. Friedman, Samuel J. Asirvatham

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Echocardiographically detected patent foramen ovale (PFO) has been associated with stroke/transient ischemic attack (TIA) in patients with cardiac implantable electronic devices (CIEDs). We sought to evaluate the relationship between echocardiographic characteristics and risk of stroke/TIA and mortality in CIED patients with PFO. Methods: In 6,086 device patients, PFO was detected in 319 patients. A baseline echocardiogram was present in 250 patients, with 186 having a follow-up echocardiogram. Results: Of 250 patients with a baseline echocardiogram, 9.6% (n = 24) had a stroke/TIA during mean follow-up of 5.3 ± 3.1 years; and 42% (n = 105) died over 7.1 ± 3.7 years. Atrial septal aneurysm, prominent Eustachian valve, visible shunting across PFO, baseline or change in estimated right ventricular systolic pressure (RVSP)/tricuspid regurgitation (TR), or maximum RVSP were not associated with postimplant stroke/TIA (P > 0.05). An exploratory multivariate analysis using time-dependent Cox models showed increased hazard of death in patients with increase in TR ≥2 grades (hazard ratio [HR] 1.780, 95% confidence interval [CI] 1.447–2.189, P < 0.0001), or increase in RVSP by >10 mm Hg (HR 2.018, 95% CI 1.593–2.556, P < 0.0001), or maximum RVSP in follow-up (HR 1.432, 95% CI 1.351–1.516, P < 0.0001). A significant increase (P < 0.001) in TR was also noted during follow-up. Conclusions: In patients with CIED and PFO, structural and hemodynamic echocardiographic markers did not predict future stroke/TIA. However, a significantly higher TR or RVSP was associated with higher mortality.

Original languageEnglish (US)
Pages (from-to)310-322
Number of pages13
JournalPACE - Pacing and Clinical Electrophysiology
Issue number3
StatePublished - Mar 1 2017


  • defibrillator
  • echocardiography
  • leads
  • pacemaker
  • patent foramen ovale
  • stroke
  • transient ischemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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