Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 16:34:100780.
doi: 10.1016/j.ijcha.2021.100780. eCollection 2021 Jun.

Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis

Jean Jacques Noubiap  1 , Thomas A Agbaedeng  1 , Joseph Kamtchum-Tatuene  2 , John L Fitzgerald  1   3 , Melissa E Middeldorp  1   3 , Timothy Kleinig  4   5 , Prashanthan Sanders  1   3
Affiliations

Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis

Jean Jacques Noubiap et al. Int J Cardiol Heart Vasc. .

Abstract

Objective: To summarize data on atrial fibrillation (AF) detection rates and predictors across different rhythm monitoring strategies in patients with cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS).

Methods: MEDLINE, Embase, and Web of Science were searched to identify all published studies providing relevant data through July 6, 2020. Random-effects meta-analysis method was used to pool estimates.

Results: We included 47 studies reporting on a pooled population of 8,215 patients with CS or ESUS. Using implantable cardiac monitor (ICM), the pooled rate of AF was 12.2% (95% CI 9.4-15.0) at 3 months, 16.0% (95% CI 13.2-18.8) at 6 months, 18.7% (95% CI 15.7-21.7) at 12 months, 22.8% (95% CI 19.1-26.5) at 24 months, and 28.5% (95% CI 17.6-39.3) at 36 months. AF rates were significantly higher in patients with ESUS vs CS (22.0% vs 14.2%; p < 0.001) at 6 months, and in studies using Reveal LINQ vs Reveal XT ICM (19.1% vs 13.0%; p = 0.001) at 12 months. Using mobile cardiac outpatient telemetry (MCOT), the pooled rate of AF was 13.7% (95% CI 10.2-17.2) at 1 month. Predictors of AF detection with ICM included older age, CHA2DS2-VASc score, left atrial enlargement, P wave maximal duration and prolonged PR interval.

Conclusion: The yield of ICM increases with the duration of monitoring. More than a quarter of patients with CS or ESUS will be diagnosed with AF during follow-up. About one in seven patients had AF detected within a month of MCOT, suggesting that a non-invasive rhythm monitoring strategy should be considered before invasive monitoring.

Keywords: Atrial fibrillation; Cryptogenic stroke; Embolic stroke of undetermined source; Holter; Insertable cardiac monitor; Telemetry.

PubMed Disclaimer

Conflict of interest statement

Dr. Sanders reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific, CathRx and PaceMate. Dr. Sanders reports that the University of Adelaide has received on his behalf research funding, lecture and/or consulting fees from Medtronic, Abbott Medical, Boston Scientific and Microport. All other authors report no disclosures.

Figures

Fig. 1A
Fig. 1A
Panel A. Overall pooled atrial fibrillation detection rates on implantable cardiac monitor in patients with cryptogenic stroke (one week to 9 months).
Fig. 1B
Fig. 1B
Panel B. Overall pooled atrial fibrillation detection rates on implantable cardiac monitor in patients with cryptogenic stroke (12 months to 36 months).
Fig. 2
Fig. 2
Relationship of atrial fibrillation detection with duration of monitoring in patients with cryptogenic stroke. Legend: the black bold line and dot lines represent the curves of atrial fibrillation detection and the upper and lower limits of the 95% confidence interval.
Fig. 3
Fig. 3
Univariable correlates of atrial fibrillation detection on implantable cardiac monitors in patients with cryptogenic stroke.
Fig. 4
Fig. 4
Overall pooled atrial fibrillation detection rates on mobile cardiac outpatient telemetry in patients with cryptogenic stroke.
See this image and copyright information in PMC

Comment in

References

    1. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 390(10100) (2017) 1260–344. - PMC - PubMed
    1. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 390(10100) (2017) 1151–210. - PMC - PubMed
    1. Li L., Yiin G.S., Geraghty O.C., Schulz U.G., Kuker W., Mehta Z., Rothwell P.M. Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study. Lancet Neurol. 2015;14(9):903–913. - PMC - PubMed
    1. Schnabel R.B., Haeusler K.G., Healey J.S., Freedman B., Boriani G., Brachmann J. Searching for Atrial Fibrillation Poststroke A White Paper of the AF-SCREEN International Collaboration. Circulation. 2019;140(22):1834–1850. - PubMed
    1. Kaarisalo M.M., Immonen-Räihä P., Marttila R.J., Salomaa V., Kaarsalo E., Salmi K. Atrial fibrillation and stroke. Mortality and causes of death after the first acute ischemic stroke. Stroke. 1997;28(2):311–315. - PubMed

LinkOut - more resources