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Insertable cardiac monitors for detection of atrial fibrillation after cryptogenic stroke: a meta-analysis

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Abstract

Background

In recent years, the implantable cardiac monitors (ICM) have enhanced the recognition ability of atrial fibrillation (AF), which makes ICM have a new application in AF detection. We conducted a meta-analysis to determine the total incidence of newly found AF detected by ICM after cryptogenic stroke and to evaluate the factors related to the detection of AF.

Methods

A literature search was conducted in the PubMed, EMBASE, Web of Science, and Cochrane library databases until March 1, 2020. Studies that reported the detection rate of AF using ICM in cryptogenic stroke patients with negative initial AF screening were analyzed.

Results

A total of 23 studies were included. The overall proportion of AF detected by ICM in cryptogenic stroke patients was 25% (95% confidence interval [CI], 22–29%). The rate of AF detected by ICM was independently related to both cardiac monitoring time (coefficient = 0.0003; 95% CI, 0.0001–0.0005; P = 0.0001) and CHA2DS2-VASc score (coefficient = 0.0834; 95% CI, 0.0339–0.1329; P = 0.001). In subgroup analysis, we found a significant difference in the detection rate of AF for monitoring duration (< 6 months: 9.6% [95% CI, 4.4–16.4%]; ≥ 6 and ≤ 12 months: 19.3% [95% CI, 15.9–23.0%]; > 12 and ≤ 24 months: 23.6% [95% CI, 19.9–27.5%]; > 24 months and ≤ 36 months: 36.5% [95% CI, 24.2–49.9%]; P < 0.001), and continent (Europe: 26.5% [95% CI, 22.2–31.0%]; North America: 16.0% [95% CI, 10.3–22.6%]; Asia: 17.4% [95% CI, 12.4–23.0%]; P = 0.005).

Conclusions

The longer the time of ICM monitoring after cryptogenic stroke, the higher the detection rate of AF. Further research is still needed to determine the optimal duration of long-term cardiac monitoring.

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Funding

This work was supported by the National Key Research and Development Program of China (2017YFC0114300); the National Basic Research Priorities Program of Jiangsu Province (Grant No. BK20160347); the Jiangsu Province’s Key Provincial Talents Program (Grant No. QNRC2016730); and the Health and Family Planning Commission of Jiangsu Province (Grant No. Z2017011).

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  1. Yue Lu and Shan-shan Diao contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital of Soochow University, No. 899, **hai Road, Suzhou, Jiangsu, China

    Yue Lu, Shan-shan Diao, Shuang-jiao Huang, Jie-ji Zhao, Meng-fan Ye, Yan Kong & Zhuan Xu

  2. Department of Radiology, The First Affiliated Hospital of Soochow University, No. 899, **hai Road, Suzhou, Jiangsu, China

    Fei-rong Yao

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  1. Yue Lu
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Lu, Y., Diao, Ss., Huang, Sj. et al. Insertable cardiac monitors for detection of atrial fibrillation after cryptogenic stroke: a meta-analysis. Neurol Sci 42, 4139–4148 (2021). https://doi.org/10.1007/s10072-021-05104-6

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