Atrial fibrillation post central retinal artery occlusion: Role of implantable loop recorders

Abstract

Objective This study evaluated the risk of subclinical atrial fibrillation (AF) in patients with central retinal artery occlusion (CRAO) compared to those with cryptogenic stroke using implantable loop recorders (ILR). Methods We conducted a retrospective analysis of 273 consecutive patients who had ILRs inserted at our institution for either cryptogenic stroke (n = 227) or CRAO (n = 46). Our primary endpoint was a time to event analysis for the new diagnosis of AF by ILR. Univariable and multivariable Cox proportional hazard models were used to determine the predictors of time‐to‐AF. Results A total of 64 patients were found to have newly diagnosed AF by remote monitoring of the ILR. AF was detected in 57 of 227 (25%) cryptogenic stroke patients by the end of a maximum 5.1 years follow‐up and in seven of 46 (15%) CRAO patients by the end of a maximum 3.6 years follow‐up (P = .215, log‐rank test). The Kaplan‐Meier estimates for freedom from AF was 59.4% for CRAO and 66.6% for cryptogenic stroke (P = NS, log‐rank test). Baseline variables predicting AF included older patients, higher CHADS2VASC score, longer PR interval on initial EKG evaluation, and mitral annular calcification on transthoracic echocardiogram. Conclusions Patients with CRAO are at risk for subclinical AF, similar to those with cryptogenic stroke. Long‐term monitoring to detect AF may lead to changes in pharmacotherapy to reduce the risk for subsequent stroke.

Central retinal artery occlusion after catheter ablation of atrial fibrillation

“…AF was a cause of CRAO. A previous study using implantable loop recorders reported that 15% of CRAO patients had subclinical AF 8 …”

“…A previous study using implantable loop recorders reported that 15% of CRAO patients had subclinical AF. 8 There have been few reports of ophthalmic complications of AF ablation. Although a previous study showed one patient developed a unilateral quadrantanopsia consistent with a retinal artery embolus after catheter ablation, 9 there have been no reports about CRAO with complete unilateral visual loss.…”

Central retinal artery occlusion after catheter ablation of atrial fibrillation

“…A previous study using implantable loop recorders reported that 15% of CRAO patients had subclinical AF. 8 There have been few reports of ophthalmic complications of AF ablation. Although a previous study showed one patient developed a unilateral quadrantopsia consistent with a retinal artery embolus after catheter ablation, 9 there have been no reports about CRAO with complete unilateral visual loss.…”

Relationship between atrial fibrillation and retinal artery occlusion: what we know now and how we can use it in clinical practice?

“…Most commonly, RAO is a consequence of an embolism originating from atherosclerotic plaques in the ipsilateral carotid artery, heart, or aortic arch [4,8]. Recently, the role of cardiac arrhythmias in the aetiology of RAO has also been receiving increasing attention [9][10][11][12][13][14][15][16]. Results of previous studies concerning the relationship between RAO and AF indicate that there is a correlation between AF and RAO.…”

“…Watson et al [13] used implantable event recorders to evaluate the risk of subclinical AF in patients with CRAO, compared to patients with cryptogenic stroke. The study revealed that the incidence of subclinical AF in CRAO patients was similar to that observed in the cryptogenic stroke group.…”