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Updated: Nov 3, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Detection of Atrial Fibrillation After Central Retinal Artery Occlusion
Brian Mac Grory1, Sean R Landman2, Paul D Ziegler2
1Departments of Neurology (B.M.G., Y.X., W.F.), Duke University School of Medicine, Durham, NC.
Insights
Central retinal artery occlusion (CRAO), a cause of blindness, is linked to atrial fibrillation (AF). Extended cardiac monitoring after CRAO detected new AF in nearly 50% of patients within two years.
Area of Science:
- Ophthalmology
- Cardiology
- Neurology
Background:
- Central retinal artery occlusion (CRAO) is a sudden, irreversible cause of blindness and a type of acute ischemic stroke.
- The study investigated the incidence of atrial fibrillation (AF) detection following CRAO.
Purpose of the Study:
- To determine the proportion of patients with CRAO who are diagnosed with new-onset atrial fibrillation (AF) through extended cardiac monitoring.
- To compare the incidence of AF in CRAO patients with matched controls and patients who experienced cerebral ischemic stroke.
Main Methods:
- A retrospective, observational cohort study utilized deidentified electronic health records and cardiac monitoring data.
- Patients were categorized into three groups: CRAO, cerebral ischemic stroke, and age-, sex-, and comorbidity-matched controls.
- The primary endpoint was the detection of new AF (≥2 minutes) via cardiac monitoring devices.
Main Results:
- The cumulative incidence of new AF within two years post-CRAO was 49.6%.
- Patients with CRAO exhibited a higher rate of AF detection compared to controls (HR, 1.64) and a comparable rate to ischemic stroke patients (HR, 1.01).
- CRAO was associated with an increased incidence of new stroke compared to controls (HR, 2.85).
Conclusions:
- The rate of AF detection after CRAO is significantly higher than in matched controls and similar to that observed after ischemic cerebral stroke.
- Paroxysmal AF should be considered in the differential diagnosis for CRAO.
- Long-term cardiac monitoring may benefit patients following CRAO.
Background:
Central retinal artery occlusion (CRAO) causes sudden, irreversible blindness and is a form of acute ischemic stroke. In this study, we sought to determine the proportion of patients in whom atrial fibrillation (AF) is detected by extended cardiac monitoring after CRAO.
Methods:
We performed a retrospective, observational cohort study using data from the Optum deidentified electronic health record of 30.8 million people cross-referenced with the Medtronic CareLink database of 2.7 million people with cardiac monitoring devices in situ. We enrolled patients in 3 groups: (1) CRAO, (2) cerebral ischemic stroke, and (3) age-, sex-, and comorbidity-matched controls. The primary end point was the detection of new AF (defined as ≥2 minutes of AF detected on a cardiac monitoring device).
Results:
We reviewed 884 431 patient records in common between the two databases to identify 100 patients with CRAO, 6559 with ischemic stroke, and 1000 matched controls. After CRAO, the cumulative incidence of new AF at 2 years was 49.6% (95% CI, 37.4%–61.7%). Patients with CRAO had a higher rate of AF than controls (hazard ratio, 1.64 [95% CI, 1.17–2.31]) and a comparable rate to patients with stroke (hazard ratio, 1.01 [95% CI, 0.75–1.36]). CRAO was associated with a higher incidence of new stroke compared with matched controls (hazard ratio, 2.85 [95% CI, 1.29–6.29]).
Conclusions:
The rate of AF detection after CRAO is higher than that seen in age-, sex-, and comorbidity-matched controls and comparable to that seen after ischemic cerebral stroke. Paroxysmal AF should be considered as part of the differential etiology of CRAO, and those patients may benefit from long-term cardiac monitoring.
