Key result
ICMs detect AF in ~29% of cryptogenic stroke or ESUS patients at three years.
Why the study?
To summarize data on AF detection rates and predictors across different rhythm monitoring strategies in patients with cryptogenic stroke or embolic stroke of undetermined source.
What are the atrial fibrillation detection rates and predictors across different rhythm monitoring strategies in patients with cryptogenic stroke or ESUS?
Meta-Analysis (n=8,215)
What are the atrial fibrillation detection rates and predictors across different rhythm monitoring strategies in patients with cryptogenic stroke or ESUS?
Non-invasive rhythm monitoring detects AF in about 1 in 7 patients within a month, suggesting it should be considered before invasive monitoring in patients with cryptogenic stroke.
Supports prolonged ICM use in cryptogenic stroke; extends evidence on AF prevalence in ESUS.
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: -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.
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Noubiap et al. (2021) conducted a meta-analysis in Cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS) (n=8,215). Implantable cardiac monitor (ICM) was evaluated on Atrial fibrillation detection rate at 36 months (95% CI 17.6-39.3). Implantable cardiac monitors detected atrial fibrillation in 28.5% of patients with cryptogenic stroke or embolic stroke of undetermined source after 36 months of monitoring.
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