J Stroke.
2019 Sep;21(3):302-311. 10.5853/jos.2019.01067.
Duration of Implantable Cardiac Monitoring and Detection of Atrial Fibrillation in Ischemic Stroke Patients: A Systematic Review and Meta-Analysis
- Affiliations
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- 1Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. tsivgoulisgiorg@yahoo.gr
- 2Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.
- 3Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece.
- 4Department of Neurology, Essen University Hospital, Essen, Germany.
- 5Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
- 6Department of Neurology, University Hospital of Geneva, Geneva, Switzerland.
- 7Second Department of Cardiology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
- 8Department of Neurology, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece.
- 9Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany.
- 10Department of Primary Education, University of Ioannina, Ioannina, Greece.
- 11Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany.
- KMID: 2464647
- DOI: http://doi.org/10.5853/jos.2019.01067
Abstract
- BACKGROUND AND PURPOSE
Current guidelines do not provide firm directions on atrial fibrillation (AF) screening after ischemic stroke (IS). We sought to investigate the association of implantable cardiac monitoring (ICM) duration with the yield of AF detection in IS patients.
METHODS
We included studies reporting AF detection rates by ICM in IS patients with negative initial AF screening. We excluded studies reporting prolonged cardiac monitoring with devices other than ICM, not providing AF detection rates or monitoring duration, and reporting overlapping data for the same population. The random-effects model was used for all pooled estimates and meta-regression analyses.
RESULTS
We included 28 studies (4,531 patients, mean age 65 years). In meta-regression analyses, the proportion of AF detection by ICM was independently associated with monitoring duration (coefficient=0.015; 95% confidence interval [CI], 0.005 to 0.024) and mean patient age (coefficient=0.009; 95% CI, 0.003 to 0.015). No associations were detected with other patient characteristics, including IS subtype (cryptogenic vs. embolic stroke of undetermined source) or time from IS onset to CM implantation. In subgroup analyses, significant differences (P<0.001) in the AF detection rates were found for ICM duration (<6 months: 5% [95% CI, 3% to 6%]; ≥6 and ≤12 months: 21% [95% CI, 16% to 25%]; >12 and ≤24 months: 26% [95% CI, 22% to 31%]; >24 months: 34% [95% CI, 29% to 39%]).
CONCLUSIONS
Extended duration of ICM monitoring and increased patient age are factors that substantially increase AF detection in IS patients with initial negative AF screening.
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