- Use causal attribution to select patients; apply ROPE score and PFO-Associated Stroke Causal Likelihood to identify those who benefit from closure.
- Delay closure until atrial fibrillation is excluded; define indication thresholds and circumstances to withhold closure based on risk assessment.
- Procedure choices, device selection, antithrombotic strategy, and AF management are key; heart-brain team judgement for patients over 60 and monitoring uncertainty.
Heart Fail Clin. 2026 Oct;22(4):439-449. doi: 10.1016/j.hfc.2026.07.004. Epub 2026 Aug 4.
ABSTRACT
Patent foramen ovale (PFO) is the commonest interatrial communication and a frequent, though often incidental, finding after cryptogenic stroke. Selecting whom to treat rests on causal attribution: the Risk of Paradoxic Embolism score and PFO-Associated Stroke Causal Likelihood classification identify the patients in whom closure works. Deciding when to treat sets the indication threshold, defines when to withhold closure, and requires excluding atrial fibrillation (AF) first. Treating well covers the procedure, device and antithrombotic strategy, and management of the AF trade-off. Uncertainty persists in patients aged more than 60 and in preclosure rhythm monitoring, where heart-brain team judgment matters most.
PMID:42716654 | DOI:10.1016/j.hfc.2026.07.004
Share Evidence Blueprint
Save to Google Notes
Search Google Scholar
Save as PDF
⭐ My Revision List
