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. [Figure: see text]