Implantable cardiac devices with patent foramen ovale--a risk factor for cardioembolic stroke?

A quarter of patients with implanted cardiac devices have a patent foramen ovale (PFO). Thrombus is frequently noted on intravascular leads that in the presence of a PFO could result in cerebral vascular embolic events. However, whether this mechanism of stroke occurs is not clearly known. We report three patients with PFO, implanted leads with thrombus, and stroke, including a patient where thrombus partially attached to the lead was seen traversing the PFO.