Key result
Atrial fibrillation detection rates using cardiac monitoring for ≤7 days were similar in patients with large vessel (2.2%) and small vessel stroke (2.4%).
Why the study?
What is the yield of atrial fibrillation detection using short-term cardiac monitoring in patients with stroke due to large or small vessel disease?
Meta-Analysis (n=5,687)
What is the yield of atrial fibrillation detection using short-term cardiac monitoring in patients with stroke due to large or small vessel disease?
Absolute Event Rate: 2.2% vs 2.4%
Short-term cardiac monitoring (≤7 days) yields a low and similar rate of atrial fibrillation detection (2.2-2.4%) in patients with large and small vessel strokes, highlighting the need for trials on extended monitoring.
Short-term monitoring yields low AF detection in large- and small-vessel stroke; leaves open whether extended strategies improve outcomes.
BACKGROUND: Recent trials have demonstrated that extended cardiac monitoring increases the yield of paroxysmal atrial fibrillation (AF) detection in patients with cryptogenic stroke. The utility of extended cardiac monitoring is uncertain among patients with stroke caused by small and large vessel disease. We conducted a meta-analysis to estimate the yield of AF detection in this population. METHODS AND RESULTS: We searched PubMed, Cochrane, and SCOPUS databases for studies on AF detection in stroke patients and excluded studies restricted to patients with cryptogenic stroke or transient ischemic attack. We abstracted AF detection rates for 3 populations grouped by stroke etiology: large vessel stroke, small vessel stroke, and stroke of undefined etiology (a mixture of cryptogenic, small vessel, large vessel, and other stroke etiologies). Our search yielded 30 studies (n=5687). AF detection rates were similar in patients with large vessel (2.2%, 95% CI 0.3-5.5; n=830) and small vessel stroke (2.4%, 95% CI 0.4-6.1; n=520). No studies had a monitoring duration longer than 7 days. The yield of AF detection in the undefined stroke population was higher (9.2%; 95% CI 7.1-11.5) compared to small vessel stroke (P=0.02) and large vessel stroke (P=0.02) populations. CONCLUSIONS: AF detection rate is similar in patients with small and large vessel strokes (2.2-2.4%). Because no studies reported on extended monitoring (>7 days) in these stroke populations, we could not estimate the yield of AF detection with long-term cardiac monitoring. Randomized controlled trials are needed to examine the utility of AF detection with long-term cardiac monitoring (>7 days) in this patient population.
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Demeestere et al. (2016) conducted a meta-analysis in Stroke due to large or small vessel disease (n=5,687). Cardiac monitoring was evaluated on Atrial fibrillation detection rate. Atrial fibrillation detection rates using cardiac monitoring for ≤7 days were similar in patients with large vessel (2.2%) and small vessel stroke (2.4%).
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