Incidence of atrial fibrillation in patients with central retinal artery occlusion: A Systematic Review and Meta-Analysis

Funding Acknowledgements Type of funding sources: None. Background Central retinal artery occlusion (CRAO) is a devastating event and atrial fibrillation (AF) is a recognized cause that may not be present at the time of the event. Purpose We performed a meta-analysis for the association of CRAO with the risk of new-onset AF and stroke during follow-up. Methods We searched the databases MEDLINE, Embase and SCOPUS from inception to May 2022 for the terms ‘atrial fibrillation’ and ‘retinal artery occlusion’ and identified 205 studies. We excluded duplicates, non-relevant studies and those not reporting new-onset AF after CRAO. We used random effects models to calculate the pooled odds ratio (OR) and 95% confidence intervals (CI) of AF risk in patients with CRAO or stroke in comparison to control groups. Analysis was performed with RevMan 5.4.1 (Cochrane 2020). Results We included 7 studies with 1.476 patients with CRAO compared to a control group without CRAO (n=9.843) and a group with stroke (n=7.058). There were 196 new AF cases (13.4%) in 18 months after CRAO. CRAO was associated with a higher risk for new-onset AF (OR:1.59, CI:1.20-2.11, p=0.001) and stroke (OR:2.46, CI:1.74-3.47, p<0.001) when compared to controls. However, the risk for AF after CRAO was similar to that after a stroke (OR:0.83, CI:0.41-1.71, p=0.62). Conclusions CRAO is associated with a higher risk for new-onset AF and stroke. AF risk after CRAO though is similar to that after stroke. Thus, CRAO should be regarded as cryptogenic stroke and mandate a closer follow-up with screening for AF and evaluation of early anticoagulation.