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Atrial fibrillation post central retinal artery occlusion: Role of implantable loop recorders
Ryan A Watson1, Jennifer Wellings1, Rittu Hingorani1
1Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.
Insights
Patients with central retinal artery occlusion (CRAO) face a similar risk of developing subclinical atrial fibrillation (AF) as those with cryptogenic stroke. Long-term monitoring with implantable loop recorders (ILR) is crucial for early AF detection and stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Ophthalmology
Background:
- Subclinical atrial fibrillation (AF) is a significant risk factor for stroke.
- Central retinal artery occlusion (CRAO) is a rare but serious condition affecting vision.
- The association between CRAO and subclinical AF requires further investigation.
Purpose of the Study:
- To evaluate the incidence of subclinical atrial fibrillation (AF) in patients with central retinal artery occlusion (CRAO).
- To compare the risk of AF in CRAO patients versus cryptogenic stroke patients using implantable loop recorders (ILR).
Main Methods:
- Retrospective analysis of 273 patients with ILRs for cryptogenic stroke (n=227) or CRAO (n=46).
- Primary endpoint: time to new AF diagnosis via ILR.
- Univariable and multivariable Cox proportional hazard models used to identify AF predictors.
Main Results:
- Newly diagnosed AF detected in 64 patients (25% cryptogenic stroke, 15% CRAO).
- No statistically significant difference in AF detection rates between CRAO and cryptogenic stroke groups (P=.215).
- Predictors of AF included older age, higher CHADS2 VASC score, prolonged PR interval, and mitral annular calcification.
Conclusions:
- Patients with CRAO exhibit a risk for subclinical AF comparable to cryptogenic stroke patients.
- Long-term ILR monitoring in CRAO patients can detect subclinical AF.
- Early AF detection may guide pharmacotherapy to mitigate subsequent stroke risk.
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 CHADS2 VASC 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.
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