P33 SUPRAVENTRICULAR TACHYARRHYTHMIAS AND RECURRENT SYNCOPES AFTER PERCUTANEOUS CLOSURE OF PFO IN A YOUNG PATIENT WITH NO HISTORY OF THROMBOEMBOLISM. IMPORTANCE OF CURRENT GUIDELINES

Abstract

Abstract The presence of a PFO (patent foramen ovale) has been associated with cryptogenic stroke in particular in the young adult, sustained by paradoxical embolism. Its percutaneous closure represents a prophylactic treatment. The procedure can involve various post–procedural complications including supraventricular tachyarrhythmias related to the mechanical action exerted by the device. The clinical case presented concerns a 49–year–old woman with a negative cardiovascular history, suffering from headache, who came to the emergency room due to the onset of relapsing episodes of symptomatic cardiopalmus due to dizziness and syncope. The ECG documented the presence of a high–frequency supraventricular tachyarrhythmia treated by external electrical cardioversion as the patient was pale and hypotensive. The laboratory tests were normal as well as the echocardiogram. The patient had undergone, three weeks earlier, percutaneous closure of PFO diagnosed following the finding of brain ischemic areas on magnetic resonance imaging (MRI) performed only to complete the diagnosis of the headache. The patient was then admitted to Cardiology where further arrhythmic relapses occurred, including a 2:1 atrial flutter treated effectively with amiodarone, a drug then introduced orally. Given the recent interventional procedure, pharmacological prophylaxis of arrhythmias was opted for, with benefit as the episodes have progressively reduced in terms of frequency and intensity. At two–months FU the patient reported only two episodes per week until complete regression, after a further 4 months. This allowed the suspension of amiodarone. Several studies and the latest guidelines indicate PFO closure in the case of stroke in patients under the age of 60 clearly correlated with paradoxical embolism; in our case, the procedure was performed after the occasional finding of ischemic micro–areas on MRI considered secondary to PFO in the absence of multidisciplinary cardiological–neurological evaluation and in a symptomatic patient only for headache. The patient had significant arrhythmic complications that had an important impact on her quality of life, also from a psychological point of view, for at least 6 months. Compared to the past, current guidelines have filled a gap that often led to “lightly” performing procedures whose complications can be really important.