Risk of incident atrial fibrillation in patients presenting with retinal artery or vein occlusion: a nationwide cohort study

Abstract

BackgroundThe inter-relationships of atrial fibrillation (AF) to retinal vascular occlusions (whether retinal artery occlusion (RAO) or retinal venous occlusion (RVO)) remain unclear. It is unknown if a presentation of retinal artery or venous occlusions may indicate a new onset cardiac arrhythmia. To shed light on this association, we investigated the risk of new onset AF in patients with known RAO and RVO.MethodsPatients with retinal occlusions from 1997 to 2011 were identified through Danish nationwide registries and matched 1:5 according to sex and age. Cumulative incidence and unadjusted rates of AF according to retinal vascular occlusions (i.e. RAO or RVO) were determined. Hazard ratios (HR) of AF according to retinal vascular occlusion were adjusted for hypertension, diabetes, vascular disease and prior stroke/systemic thromboembolism/transient ischemic attack.ResultsOne thousand three hundred sixty-eight cases with retinal vascular occlusions were identified (median age 71.4 (inter quartile range (IQR); 61.2–79.8), 47.3% male). RAO constituted 706 cases (51.6%) and RVO 529 (38.7%). The rate of incident AF amongst all cases with retinal vascular occlusion was 1.74 per 100 person-years (95% confidence interval (CI), 1.47–2.06) compared to 1.22 (95% CI, 1.12–1.33) in the matched control group. The rate of AF in RAO was 2.01 (95% CI, 1.6–2.52) and 1.52 (1.15–2.01) in RVO. HRs of incident AF adjusted for cardiovascular comorbidities were 1.26 (95% CI; 1.04–1.53, p = 0.019) for any retinal vascular occlusion, 1.45 (95% CI; 1.10–1.89, p = 0.015) for RAO, and 1.02 (95% CI; 0.74–1.39, p = 0.920) for RVO.ConclusionsA new diagnosis of retinal vascular occlusion in patients without prior AF was associated with increased risk of incident AF, particularly amongst patients with RAO. Awareness of AF in patients with retinal vascular occlusions is advised.

Associations of new-onset atrial fibrillation and severe visual impairment in type 2 diabetes: A multicenter nationwide study

“…Previous studies from Hayreh et al [ 21 ] and Yen et al [ 19 ] draw a potential pathophysiologic association, as they have reported that patients with AF are at increased risk of developing RAO. A study by Christiansen et al [ 22 ] also found that RAO was associated with an increased risk of incident AF. O'Mahoney et al [ 23 ] and Christiansen et al [ 24 ] reported that RVO might be an important cause of blindness in populations with high atherosclerotic risk.…”

Atrial fibrillation post central retinal artery occlusion: Role of implantable loop recorders

“…Data from previous studies support the use of long‐term monitoring for detection of atrial fibrillation as short‐term ECG monitoring of 1 day to 1 month is less effective 11,12,14 . There are limited data on the association of atrial fibrillation and CRAO 5,15–17 . Previous studies have advocated cardiac monitoring for as little as 24 hours to as long as 1 month post‐CRAO.…”

Relationship between atrial fibrillation and retinal artery occlusion: what we know now and how we can use it in clinical practice?

“…Results of previous studies concerning the relationship between RAO and AF indicate that there is a correlation between AF and RAO. RAO episodes were more frequently observed in the AF group, and RAO patients were more frequently diagnosed with AF compared with control groups [9][10][11][12]. A higher rate of rehospitalization of RAO patients compared with ischemic stroke patients due to cardiac arrhythmias including AF is also noteworthy, indicating the necessity to conduct a mandatory diagnostic evaluation in this group of patients for AF [16], especially given the fact that RAO patients are at a high risk of stroke in the period immediately following RAO [6,[16][17][18][19][20].…”

“…Most commonly, RAO is a consequence of an embolism originating from atherosclerotic plaques in the ipsilateral carotid artery, heart, or aortic arch [4,8]. Recently, the role of cardiac arrhythmias in the aetiology of RAO has also been receiving increasing attention [9][10][11][12][13][14][15][16]. Results of previous studies concerning the relationship between RAO and AF indicate that there is a correlation between AF and RAO.…”

“…The risk of AF-related stroke in the case of AF patients who developed RAO, the risk of thromboembolic complications is almost 40% higher than in AF patients in whom an episode of RAO did not occur [7]. In addition, patients who have already been diagnosed with AF who develop RAO may require initiation or modification of anticoagulant treatment, the selection of which is based on stratification of thromboembolic risk based on the CHA 2 DS 2 -VASc score (Table 1) [1,4,7,9]. As most cardiogenic strokes and their recurrences can be prevented by appropriate preventive treatment, an early diagnosis of stroke aetiology, including RAO, is important.…”