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Atrial fibrillation post central retinal artery occlusion: Role of implantable loop recorders
Author(s) -
Watson Ryan A.,
Wellings Jennifer,
Hingorani Rittu,
Zhan Tingting,
Frisch Daniel R.,
Ho Reginald T.,
Pavri Behzad B.,
Sergott Robert C.,
Greenspon Arnold J.
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13990
Subject(s) - medicine , atrial fibrillation , cardiology , stroke (engine) , hazard ratio , central retinal artery occlusion , confidence interval , surgery , visual acuity , mechanical engineering , engineering
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 CHADS 2 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.