Electrocardiographic Monitoring for Detecting Atrial Fibrillation after Ischemic Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis.
Circ Arrhythm Electrophysiol. 2015 Jan 31;
Authors: Dussault C, Toeg H, Nathan M, Wang ZJ, Roux JF, Secemsky E
Abstract
BACKGROUND: -Atrial fibrillation (AF) is a major cause of stroke. While standard investigations following an event include electrocardiographic (ECG) monitoring, the optimal duration to detect AF is unclear. We performed a systematic review and meta-analysis to determine whether the duration of ECG-monitoring following an ischemic event is related to the detection of AF.
METHODS AND RESULTS: -Prospective studies that reported the proportion of new AF diagnosed using ECG-monitoring for greater than 12 hours in patients with recent stroke or TIA were analyzed. Studies were excluded if the stroke was hemorrhagic or AF was previously diagnosed. A total of 31 articles met inclusion criteria. Longer duration of monitoring was associated with an increased detection of AF when examining monitoring time as a continuous variable (p<0.001 for meta-regression analysis). When dichotomizing studies based on monitoring duration, studies with monitoring lasting ≤ 72 hours detected AF in 5.1% whereas monitoring lasting ≥ 7 days detected AF in 15%. The proportion of new diagnosis increased to 29.15% with extended monitoring for 3 months. Significant heterogeneity within studies was detected for both groups (≤72 hours: I(2) = 91.3%; ≥7 days: I(2) = 75.8). When assessing the odds of AF detection in the 3 randomized controlled trial, there was a 7.26 increased odds of AF with long-term monitoring (95% CI [3.99-12.83]; p-value <0.001).
CONCLUSIONS: -Longer duration of electrocardiographic monitoring after cryptogenic stroke is associated with a greater detection of AF. Future investigation is needed to determine the optimal duration of long-term monitoring.
PMID: 25639643 [PubMed - as supplied by publisher]