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
Meta-Analysis
. 2022 Sep;9(2):e002081.
doi: 10.1136/openhrt-2022-002081.

A meta-analysis of extended ECG monitoring in detection of atrial fibrillation in patients with cryptogenic stroke

Haowen Jiang  1 , Shyn Yi Tan  1 , Jeremy King Wang  1 , Jiaqi Li  2 , Tian Ming Tu  3 , Vern Hsen Tan  4 , Colin Yeo  5
Affiliations
Meta-Analysis

A meta-analysis of extended ECG monitoring in detection of atrial fibrillation in patients with cryptogenic stroke

Haowen Jiang et al. Open Heart. 2022 Sep.

Abstract

Objective: The aim of this systematic review is to evaluate the various modalities available for extended ECG monitoring in the detection of atrial fibrillation (AF) following a cryptogenic stroke.

Methods: MEDLINE (Ovid), EMBASE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL) were searched from January 2011 to November 2021. All randomised controlled trials and prospective cohort studies including the use of extended ECG monitoring >24 hours with a minimum duration of AF of 30 s in patients with either cryptogenic strokes or transient ischaemic attacks were included. A random-effects model was used to pool effect estimates of AF detection rates from different ECG modalities.

Results: 3924 studies were identified, of which 47 were included reporting on a pooled population of 6448 patients with cryptogenic stroke. The pooled AF rate for implantable loop recorders (ILRs) increased from 4.9% (3.0%-7.9%) at 1 month to 38.4% (20.4%-60.2%) at 36 months. Mobile cardiac outpatient telemetry (MCOT) had a significantly higher pooled AF detection rate of 12.8% (8.9%-17.9%) versus 4.9% (3.0%-7.9%) for ILR at 1 month (p<0.0001). Predictors for AF detection include duration of monitoring (p<0.0001) and age (p<0.0001) for ILRs, but only age for MCOTs (p<0.020).

Conclusion: MCOT has a higher rate of detection at 1 month and is less invasive. Beyond 1 month, compliance becomes a significant limitation for MCOT. MCOT may be a reasonable alternative AF screening tool for patients with cryptogenic stroke if ILR is not available.

Prospero registration number: CRD42022297782.

Keywords: atrial fibrillation; electrophysiology; stroke.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flow chart on study selection process. AF, atrial fibrillation; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Pooled atrial fibrillation detection rates for implantable loop recorders by duration of monitoring.
Figure 3
Figure 3
Pooled atrial fibrillation (AF) detection rates for mobile cardiac outpatient telemetry by AF duration of monitoring.
See this image and copyright information in PMC

References

    1. Ornello R, Degan D, Tiseo C, et al. . Distribution and temporal trends from 1993 to 2015 of ischemic stroke subtypes: a systematic review and meta-analysis. Stroke 2018;49:814–9. 10.1161/STROKEAHA.117.020031 - DOI - PubMed
    1. Sanna T, Diener H-C, Passman RS, et al. . Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014;370:2478–86. 10.1056/NEJMoa1313600 - DOI - PubMed
    1. Noubiap JJ, Agbaedeng TA, Kamtchum-Tatuene J, et al. . Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: a systematic review and meta-analysis. Int J Cardiol Heart Vasc 2021;34:100780. 10.1016/j.ijcha.2021.100780 - DOI - PMC - PubMed
    1. Gladstone DJ, Spring M, Dorian P, et al. . Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014;370:2467–77. 10.1056/NEJMoa1311376 - DOI - PubMed
    1. Hermans ANL, Gawalko M, Dohmen L, et al. . Mobile health solutions for atrial fibrillation detection and management: a systematic review. Clin Res Cardiol 2022;111:479–91. 10.1007/s00392-021-01941-9 - DOI - PMC - PubMed

MeSH terms