MVP ECG risk score predicts early occurrence of atrial fibrillation after patent foramen ovale percutaneous closure.

Introduction: Transcatheter patent foramen ovale (PFO) closure has emerged as the therapeutic gold standard in patients with a PFO-related stroke. New-onset atrial fibrillation appears as an early complication of this procedure. Our study aims to evaluate if the MVP (Morphology-Voltage-P wave duration) ECG risk score calculated before PFO closure might be a valuable predictor of early postprocedural atrial fibrillation occurrence.

Methods: We enrolled all consecutive patients (aged 18-65 years) who underwent percutaneous PFO closure between July 2020 and August 2023. The MVP ECG risk score was calculated. Patients were reassessed with clinical and echocardiographic follow-up at 1 month and 6 months later, to assess the efficacy and safety of the procedure as well as atrial fibrillation occurrence. Patients were then divided into two groups according to the occurrence of early atrial fibrillation after PFO closure.

Results: We enrolled 103 patients, 63.1% male (mean age 48.7 ± 10.6 years). At the end of follow-up, atrial fibrillation occurred in five patients (4.9%). When comparing groups with and without atrial fibrillation diagnosis at follow-up, there was a statistically significant difference in MVP ECG risk scores (3.0 versus 1.0; P  = 0.001). At receiver operating characteristic analysis, the MVP ECG risk score showed good diagnostic accuracy in predicting the diagnosis of atrial fibrillation at follow-up [AUC: 0.90; 95% confidence interval (CI) 0.81-0.98]. In the multivariate Cox proportional hazard model, the MVP ECG risk score remained the only independent predictor of atrial fibrillation onset (hazard ratio 2.96; 95% CI 1.13-7.71; P  = 0.03).

Conclusion: The MVP ECG risk score could be an independent predictor of early atrial fibrillation occurrence in patients undergoing percutaneous PFO closure.