Extended AF Monitoring Worth Considering After Eye Stroke
Extended cardiac monitoring for the detection of atrial fibrillation (AF) should be considered in patients who have a stroke caused by central retinal artery occlusion, a new study suggests.

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.

Researchers 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. They 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 more than 2 minutes of AF detected on a cardiac monitoring device).

-- Researchers 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%.

-- Patients with CRAO had a higher rate of AF than controls and a comparable rate to patients with stroke.

-- CRAO was associated with a higher incidence of new stroke compared with matched controls.

Conclusively, 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.

Source: https://www.ahajournals.org/doi/abs/10.1161/STROKEAHA.120.033934