{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T09:08:14Z","timestamp":1789204094872,"version":"build-2803163510"},"reference-count":27,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"unspecified","delay-in-days":71,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,8,19]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Percutaneous patent foramen ovale (PFO) closure is an established intervention for secondary prevention of cryptogenic stroke. Increasing evidence indicates that the procedure is associated with a risk of new-onset atrial fibrillation (AF). This study aimed to describe the temporal distribution and clinical factors associated with new-onset AF following percutaneous PFO closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients aged \u226516 years undergoing percutaneous PFO closure between 1999 and 2021 at a tertiary care centre were retrospectively included. New-onset AF was identified through systematic review of electronic health records. Descriptives are presented as median with IQR. Time-to-event analysis was performed using cumulative incidence functions and Cox proportional hazards regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 867 patients (median age 51 years (42\u201358), 47% female), PFO closure was performed for secondary stroke prevention in 86%. During a median follow-up of 11.7 years (6.3\u201316.8), new-onset AF occurred in 97 patients (11.2%), corresponding to an incidence rate of 1.0 per 100 patient-years. AF diagnoses clustered early after closure, with 26.8% occurring within the first 3 months. In multivariable analysis, higher age at closure (HR 1.05 per year; 95% CI 1.03 to 1.07), larger occluder device size (HR 1.09 per mm; 95%\u2009CI 1.03 to 1.16) and any moderate or severe valvular regurgitation (HR 3.70; 95%\u2009CI 1.65 to 8.33) were independently associated with new-onset AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>New-onset AF is common after PFO closure and shows early postprocedural clustering. Increasing age, larger occluder size and valvular regurgitation are independently associated with AF occurrence, underscoring the need for focused rhythm surveillance after closure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004344","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:30:21Z","timestamp":1789201821000},"page":"e004344","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term incidence and risk factors of atrial fibrillation after percutaneous patent foramen ovale occlusion: a retrospective cohort study"],"prefix":"10.1136","volume":"13","author":[{"given":"Oscar","family":"Rommens","sequence":"first","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Blondeel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Maes","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Paule","family":"Goidts","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Garweg","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"},{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Els","family":"Troost","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Haemers","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"},{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8676-4874","authenticated-orcid":false,"given":"Tomas","family":"Robyns","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"},{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Van De Bruaene","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"},{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris","family":"Ector","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"},{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rik","family":"Willems","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"},{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5850-5413","authenticated-orcid":false,"given":"Werner","family":"Budts","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"},{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"De Meester","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"},{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8296-920X","authenticated-orcid":false,"given":"Bert","family":"Vandenberk","sequence":"additional","affiliation":[{"name":"Cardiology, UZ Leuven, Leuven, Belgium"},{"name":"Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"2026091201301405000_13.2.e004344.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy649"},{"key":"2026091201301405000_13.2.e004344.2","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1093\/eurheartj\/ehaa1070","article-title":"European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions","volume":"42","author":"Pristipino","year":"2021","journal-title":"Eur Heart J"},{"key":"2026091201301405000_13.2.e004344.3","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.jcmg.2021.06.019","article-title":"Screening and Risk Stratification Strategy Reduced Decompression Sickness Occurrence in Divers With Patent Foramen Ovale","volume":"15","author":"Hon\u011bk","year":"2022","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026091201301405000_13.2.e004344.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1705915"},{"key":"2026091201301405000_13.2.e004344.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1610057"},{"key":"2026091201301405000_13.2.e004344.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707404"},{"key":"2026091201301405000_13.2.e004344.7","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.040546"},{"key":"2026091201301405000_13.2.e004344.8","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1212\/WNL.0000000000009443","article-title":"Practice advisory update summary: Patent foramen ovale and secondary stroke prevention: Report of the Guideline Subcommittee of the American Academy of Neurology","volume":"94","author":"Mess\u00e9","year":"2020","journal-title":"Neurology"},{"key":"2026091201301405000_13.2.e004344.9","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s10840-020-00925-5","article-title":"New-onset atrial fibrillation following percutaneous closure of patent foramen ovale: a systematic review and meta-analysis","volume":"60","author":"Oliva","year":"2021","journal-title":"J Interv Card Electrophysiol"},{"key":"2026091201301405000_13.2.e004344.10","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.22.8.983"},{"key":"2026091201301405000_13.2.e004344.11","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.034249","article-title":"Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management","volume":"13","author":"Apostolos","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"2026091201301405000_13.2.e004344.12","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1016\/j.hrthm.2022.05.025","article-title":"Atrial fibrillation after transcatheter patent foramen ovale closure: To measure is to know","volume":"19","author":"Vandenberk","year":"2022","journal-title":"Heart Rhythm"},{"key":"2026091201301405000_13.2.e004344.13","doi-asserted-by":"crossref","unstructured":"von Falkenhausen AS , Keidel LM , Wischmann J , et al . Atrial fibrillation after patent foramen ovale closure in patients with embolic stroke of undetermined source. Europace 2024;26. doi:10.1093\/europace\/euae141","DOI":"10.1093\/europace\/euae141"},{"key":"2026091201301405000_13.2.e004344.14","doi-asserted-by":"crossref","first-page":"3469","DOI":"10.1093\/eurheartj\/ehad305","article-title":"Long-term risk of atrial fibrillation or flutter after transcatheter patent foramen ovale closure: a nationwide Danish study","volume":"44","author":"Skibsted","year":"2023","journal-title":"Eur Heart J"},{"key":"2026091201301405000_13.2.e004344.15","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1016\/j.hrthm.2022.04.006","article-title":"Incidence of new-onset atrial fibrillation after transcatheter patent foramen ovale closure using 15 years of Ontario administrative health data","volume":"19","author":"Oliva","year":"2022","journal-title":"Heart Rhythm"},{"key":"2026091201301405000_13.2.e004344.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2018.06.004"},{"key":"2026091201301405000_13.2.e004344.17","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jeq057"},{"key":"2026091201301405000_13.2.e004344.18","doi-asserted-by":"publisher","DOI":"10.1016\/S1525-2167(00)90066-0"},{"key":"2026091201301405000_13.2.e004344.19","doi-asserted-by":"publisher","DOI":"10.7326\/M19-3583"},{"key":"2026091201301405000_13.2.e004344.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104860"},{"key":"2026091201301405000_13.2.e004344.21","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1159\/000527457","article-title":"A Systematic Review and Meta-Analysis of the Association between Residual Shunts after Patent Foramen Ovale Closure and Long-Term Cerebrovascular Events","volume":"52","author":"Liu","year":"2023","journal-title":"Cerebrovasc Dis"},{"key":"2026091201301405000_13.2.e004344.22","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi825"},{"key":"2026091201301405000_13.2.e004344.23","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2021-001624","article-title":"Age-specific atrial fibrillation incidence, attributable risk factors and risk of stroke and mortality: results from the MORGAM Consortium","volume":"8","author":"Morseth","year":"2021","journal-title":"Open Heart"},{"key":"2026091201301405000_13.2.e004344.24","doi-asserted-by":"crossref","DOI":"10.1016\/j.acvd.2025.10.172","article-title":"Atrial fibrillation following patent foramen ovale closure: Insights from a cohort study with continuous implantable cardiac monitoring","volume":"119","author":"Gautier","year":"2026","journal-title":"Arch Cardiovasc Dis"},{"key":"2026091201301405000_13.2.e004344.25","first-page":"51","article-title":"Influence of PFO Anatomy on Successful Transcatheter Closure","volume":"2","author":"Onorato","year":"2013","journal-title":"Interv Cardiol Clin"},{"key":"2026091201301405000_13.2.e004344.26","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s11739-022-03184-6","article-title":"Thoracic aortic aneurysm and atrial fibrillation: clinical associations with the risk of stroke from a global federated health network analysis","volume":"18","author":"Proietti","year":"2023","journal-title":"Intern Emerg Med"},{"key":"2026091201301405000_13.2.e004344.27","doi-asserted-by":"crossref","DOI":"10.3390\/genes12121953","article-title":"The Genetic Landscape of Patent Foramen Ovale: A Systematic Review","volume":"12","author":"Paolucci","year":"2021","journal-title":"Genes (Basel)"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2026-004344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:30:25Z","timestamp":1789201825000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2026-004344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,9,12]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/openhrt-2026-004344"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2026-004344","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}