Abstract
Purpose: To evaluate retinal and optic nerve head (ONH) perfusion in patients with atrial fibrillation (AF) before and after catheter ablation of AF with pulmonary vein isolation (PVI). Methods: 34 eyes of 34 patients with AF and 35 eyes of 35 healthy subjects were included in this study. Flow density data were obtained using spectral-domain OCT-A (RTVue XR Avanti with AngioVue, Optovue, Inc, Fremont, California, USA). The data of the superficial and deep vascular layers of the macula and the ONH (radial peripapillary capillary network, RPC) before and after PVI were extracted and analysed. Results: The flow density in the superficial OCT-angiogram (whole en face) and the ONH (RPC) in patients with AF was significantly lower compared to healthy controls (OCT-A superficial: study group: 48.77 (45.19; 52.12)%; control group: 53.01 (50.00; 54.25)%; p < 0.001; ONH: study group: 51.82 (48.41; 54.03)%; control group: 56.00 (54.35; 57.70)%; p < 0.001;). The flow density in the ONH (RPC) improved significantly in the study group following PVI (before: 51.82 (48.41; 54.03)%; after: 52.49 (50.34; 55.62)%; p = 0.007). Conclusions: Patients with AF showed altered ocular perfusion as measured using OCTA when compared with healthy controls. Rhythm control using PVI significantly improved ocular perfusion as measured using OCT-A. Non-contact imaging using OCTA provides novel information about the central global microperfusion of patients with AF.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia in industrialized countries with an increasing burden of morbidity
In a previous study by our group, we found a reduced retinal and optic nerve head (ONH) perfusion in patients with AF compared to healthy controls [13]
We initiated our study with a comparison between the study group and the healthy control group
Summary
Atrial fibrillation (AF) is the most common arrhythmia in industrialized countries with an increasing burden of morbidity. Pulmonary vein isolation (PVI) has evolved as an effective therapeutic option for patients with symptomatic AF [1]. PVI is a cornerstone of modern AF management [2] showing success rates of up to 70%. PVI is associated with a potential risk of cerebral ischemic events and a low but measurable risk of acute stroke [3]. In addition to clinically apparent neurological deficits, Doppler studies during PVI procedures have shown asymptomatic micro-embolization events during ablation [4]. Imaging studies using cerebral MRI have demonstrated a high rate of newly occurring asymptomatic cerebral lesions following PVI [5]
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