{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:00:17Z","timestamp":1786118417169,"version":"build-2736575974"},"reference-count":43,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Interv Cardiol"],"abstract":"<jats:p>Background: Controversy exists around AF risk after patent foramen ovale (PFO) closure. This study characterised dynamic ECG changes over 6 months after Amplatzer closure, focusing on electrical remodelling. Methods: In all, 246 PFO patients underwent serial ECGs (P wave dispersion [PWD], PR interval, QRS, corrected QT interval [QTc]) and echocardiography before PFO closure and 24 hours and 1, 3 and 6 months after closure. Temporal changes were analysed. Subgroup analyses evaluated ECG changes according to comorbidity (migraine or cerebral infarction). Results: PWD increased significantly at 24 hours and peaked at 1 month, remaining elevated compared with baseline at 6 months (p&lt;0.001). Of all patients, 5.3% had PWD \u226540 ms. The PR interval was significantly shortened after PFO closure, with this persisting at 6 months (p&lt;0.001). AF occurred in six (2.4%) patients and supraventricular tachycardia occurred in eight (3.3%). QRS and QTc were stable. With regard to cardiac structure\/function, no significant echocardiographic changes were seen from before to after PFO closure. In subgroups analyses, PR shortening was greater in patients with migraine than in those with cerebral infarction (p&lt;0.001). Conclusion: PFO closure induced a transient elevation in PWD and sustained PR shortening. Under limited spot ECG monitoring, no clinically significant arrhythmias or structural changes were detected. However, extended surveillance is warranted to evaluate potential late-onset arrhythmogenic sequelae.<\/jats:p>","DOI":"10.15420\/icr.2025.36","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:24:59Z","timestamp":1785767099000},"source":"Crossref","is-referenced-by-count":0,"title":["Mid-term Electrical Remodelling in Surface ECG Following Percutaneous Patent Foramen Ovale Closure"],"prefix":"10.15420","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5446-1425","authenticated-orcid":false,"given":"Jingpu","family":"Yue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2389-4110","authenticated-orcid":false,"given":"Gengxu","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanzhi","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1049-5409","authenticated-orcid":false,"given":"Guanli","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Ji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Geng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Zuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref0","unstructured":"Mas JL, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 2017;377:1011\u201321. https:\/\/doi.org\/10.1056\/NEJMoa1705915; PMID: 28902593."},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"S\u00f8ndergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 2017;377:1033\u201342. https:\/\/doi.org\/10.1056\/NEJMoa1707404; PMID: 28902580. DOI: 10.1056\/NEJMoa1707404","DOI":"10.1056\/NEJMoa1707404"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Saver JL, Carroll JD, Thaler DE, et al. Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 2017;377:1022\u201332. https:\/\/doi.org\/10.1056\/NEJMoa1610057; PMID: 28902590. DOI: 10.1056\/NEJMoa1610057","DOI":"10.1056\/NEJMoa1610057"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association. Stroke 2021;52:e364\u2013467. https:\/\/doi.org\/10.1161\/STR.0000000000000375; PMID: 34024117. DOI: 10.1161\/STR.0000000000000383","DOI":"10.1161\/STR.0000000000000383"},{"key":"ref4","unstructured":"Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021;42:3227\u2013337. https:\/\/doi.org\/10.1093\/eurheartj\/ehab484; PMID: 34458905."},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Mess\u00e9 SR, Gronseth GS, Kent DM, et al. Practice advisory update summary: patent foramen ovale and secondary stroke prevention. 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Electrocardiographic changes and arrhythmias following percutaneous atrial septal defect and patent foramen ovale device closure. Catheter Cardiovasc Interv 2011;78:254\u201361. https:\/\/doi.org\/10.1002\/ccd.23028; PMID: 21563292. DOI: 10.1002\/ccd.23028","DOI":"10.1002\/ccd.23028"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Leclercq F, Odorico X, Marin G, et al. Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: a prospective study. Int J Cardiol Heart Vasc 2021;37:100919. https:\/\/doi.org\/10.1016\/j.ijcha.2021.100919; PMID: 34849392. DOI: 10.1016\/j.ijcha.2021.100919","DOI":"10.1016\/j.ijcha.2021.100919"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Kibler M, Marzak H, Jesel L, Ohlmann P. High-grade atrioventricular block occurring during percutaneous closure of patent foramen ovale: a case report. 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