title: Transcatheter closure of patent foramen ovale in older adults.
abstract: OBJECTIVE
  Comparing results of patent foramen ovale (PFO) closure in older and younger patient cohorts.
  
  
  BACKGROUND
  The literature pertaining to stroke and PFO has focused on patients <55 years of age.
  
  
  METHODS
  Between March 2000 and December 2003, 456 consecutive stroke/transient ischemic attack (TIA) patients (14.2-91.1 years, mean 51.4 +/- 15.5) underwent successful closure of PFO with a CardioSEAL Septal Occluder by one operator at five hospitals. Of the 456 patients, 184 (40.4%) were >55 years of age at the time of the procedure (mean 66.9 +/- 8.3 years) and comprise the subject group (OLDER). The remaining 272 patients (mean 41.1 +/- 7.7) comprise the control group (YOUNGER). Data were collected prospectively in a registry type format.
  
  
  RESULTS
  Minor procedural complications were comparable: 7/184 (3.8%) OLDER vs. 12/272 (4.4%) YOUNGER (P = NS). In the follow-up period (1-45 months, mean = 17.8 +/- 11.1), there was no significant difference in the rate of recurrent stroke/TIA, headaches, or late unrelated death. Forty OLDER patients and 47 YOUNGER developed new onset atrial arrhythmia (P = NS). The incidence of new onset atrial fibrillation (AF), however, was significantly higher in OLDER (14/40 OLDER and only 2/47 YOUNGER, P < 0.025). All patients who were in normal sinus rhythm (NSR) before the procedure are in NSR at last follow-up.
  
  
  CONCLUSIONS
  Older patients should not be excluded from PFO closure. The procedure seems as safe and effective in preventing recurrent stroke in the older, as in the younger population. Older patients seem more prone to developing AF.
authors.affiliation: Division of Pediatric Cardiology, St. Joseph Children's Hospital, Paterson, NJ 07503, USA. kiblawif@sjhmc.org
authors.forename: Fuad M
authors.initials: FM
authors.lastname: Kiblawi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sommer
authors.forename: Sean G
authors.initials: SG
authors.lastname: Levchuck
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000209:etiology*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D006261:Headache / Q000209:etiology; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012107:Research Design; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome