Right focal atrial tachycardia following closure of patent foramen ovale with an amplatzer septal occluder device: case report

Transcatheter closure of patent foramen ovale (PFO) is increasingly performed after cryptogenic stroke, but it may predispose to atrial arrhythmias. We report a rare case of late-onset right focal atrial tachycardia following PFO closure with an Amplatzer septal occluder device.

A 76-year-old man with no prior arrhythmia history underwent percutaneous PFO closure with a 25 mm Amplatzer device after a cryptogenic stroke. Three years later, he presented with symptomatic palpitations. Electrocardiography showed a focal atrial tachycardia. Electrophysiologic study and 3D mapping revealed a right atrial tachycardia originating at the site of the Amplatzer device scar. Radiofrequency ablation at this site successfully terminated the tachycardia, with no recurrence during follow-up.

This case illustrates the potential for late-onset right atrial tachycardia due to scarring and altered conduction around the PFO occluder. The site-specific reentry mechanism and delayed presentation may be related to progressive endothelialization of the device. To our knowledge, this is the first reported case of right atrial tachycardia occurring years after PFO closure and successfully treated with ablation.

Radiofrequency ablation is a safe and effective treatment for device-related arrhythmias, offering symptom resolution and potentially preventing recurrence.