Atrial fibrillation post central retinal artery occlusion: Role of implantable loop recorders. Issue 9 (18th August 2020) - Watson, Ryan A.
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 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.