{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:30:29Z","timestamp":1787729429173,"version":"build-2784847793"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2013,9,24]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>A patent foramen ovale (PFO) may permit arterial embolization of thrombi that accumulate on the leads of cardiac implantable electronic devices in the right-sided cardiac chambers. We sought to determine whether a PFO increases the risk of stroke\/transient ischemic attack (TIA) in patients with endocardial leads.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      We retrospectively evaluated all patients who had endocardial leads implanted between January 1, 2000, and October 25, 2010, at Mayo Clinic Rochester. Echocardiography was used to establish definite PFO and non-PFO cohorts. The primary end point of stroke\/TIA consistent with a cardioembolic etiology and the secondary end point of mortality during postimplantation follow-up were compared in PFO versus non-PFO patients with the use of Cox proportional hazards models. We analyzed 6075 patients (364 with PFO) followed for a mean 4.7\u00b13.1 years. The primary end point of stroke\/TIA was met in 30\/364 (8.2%) PFO versus 117\/5711 (2.0%) non-PFO patients (hazard ratio, 3.49; 95% confidence interval, 2.33\u20135.25;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001). The association of PFO with stroke\/TIA remained significant after multivariable adjustment for age, sex, history of stroke\/TIA, atrial fibrillation, and baseline aspirin\/warfarin use (hazard ratio, 3.30; 95% confidence interval, 2.19\u20134.96;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001). There was no significant difference in all-cause mortality between PFO and non-PFO patients (hazard ratio, 0.91; 95% confidence interval, 0.77\u20131.07;\n                      <jats:italic>P<\/jats:italic>\n                      =0.25).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>In patients with endocardial leads, the presence of a PFO on routine echocardiography is associated with a substantially increased risk of embolic stroke\/TIA. This finding suggests a role of screening for PFOs in patients who require cardiac implantable electronic devices; if a PFO is detected, PFO closure, anticoagulation, or nonvascular lead placement may be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.113.003540","type":"journal-article","created":{"date-parts":[[2013,8,15]],"date-time":"2013-08-15T09:00:38Z","timestamp":1376557238000},"page":"1433-1441","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":89,"title":["Stroke or Transient Ischemic Attack in Patients With Transvenous Pacemaker or Defibrillator and Echocardiographically Detected Patent Foramen Ovale"],"prefix":"10.1161","volume":"128","author":[{"given":"Christopher V.","family":"DeSimone","sequence":"first","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Friedman","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Noheria","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil A.","family":"Patel","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C.","family":"DeSimone","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Bdeir","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A.","family":"Aakre","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaibhav R.","family":"Vaidya","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua P.","family":"Slusser","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Hodge","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Ackerman","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro A.","family":"Rabinstein","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel J.","family":"Asirvatham","sequence":"additional","affiliation":[{"name":"From the Department of Internal Medicine, Mayo Clinic, Rochester, MN (C.V.D, D.C.D, C.A.A, V.R.V.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (C.V.D, P.A.F., M.J.A, S.J.A.); Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (A.N.); Mayo Medical School, Rochester, MN (N.A.P.); Mayo Graduate School of Medicine Visiting Scholars Program, Mayo Clinic, Rochester, MN (S.B.); Department of Statistics, Mayo Clinic, Rochester, MN (J.P.S., D.O.H.); Department of..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1996.tb03414.x"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.107.698597"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2003.09.115"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1540-8167.2004.04081.x"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.2006.00519.x"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eup216"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euq075"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8159.1986.tb05392.x"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.111.028647"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)60336-X"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2010.224"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-012-9712-3"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12014"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.106.622076"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.04.015"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-010-9494-4"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200104053441403"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.10.044"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000017498.88393.44"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198805053181802"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(88)92944-3"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.12.1865"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.31.10.2407"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011503"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa071422"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009639"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.111.030494"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000021920.73149.c3"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032423"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.11.038"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043399"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(96)00163-4"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.113.003540","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:34:15Z","timestamp":1715567655000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.003540"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9,24]]},"references-count":32,"journal-issue":{"issue":"13","published-print":{"date-parts":[[2013,9,24]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.113.003540"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.113.003540","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.718075845.793483658","asserted-by":"object"}]},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9,24]]},"assertion":[{"value":"2013-05-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-08-05","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-08-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}