Association between insular involvement and ECG abnormalities in ischemic stroke: a systematic review and meta-analysis

BACKGROUND Ischemic stroke in the insular cortex may influence cardiac function, presenting as ECG changes and arrhythmias attributable to autonomic imbalance. This study aims to analyze the association between insular involvement and ECG abnormalities, specifically in patients suffering from ischemic stroke. METHODS Cohort and cross-sectional studies involving ischemic stroke patients with insular involvement and a control group without insular involvement were systematically searched across five databases. The primary outcome evaluated was ECG abnormalities within the insular ischemic stroke group and the control group, while the secondary outcome encompassed ECG abnormalities comparing right versus left insular ischemic strokes. Effect sizes were expressed as odds ratios or risk ratios (95% CI). The quality and certainty of the studies were appraised using ROBINS-E and GRADE. RESULTS A total of nine studies (n = 2553) with low to moderate risk of bias were included in the systematic review. Patients with insular ischemic stroke exhibited a higher inclination for atrial or ventricular rhythm disturbances (atrial fibrillation OR 2.86 (1.52-5.38), p = 0.001; ventricular extrasystoles RR 1.29 (0.87-1.92), p = 0.20) and repolarization anomalies (QTc prolongation RR 1.56 (1.25-1.94), p < 0.0001), but no significant differences were observed regarding conduction abnormalities. Pooled multivariate logistic regression indicated increased odds of composite ECG abnormalities in the insular ischemic stroke group (OR 1.87 (1.15-3.03), p = 0.01). Rhythm disturbances appeared to be more prevalent in right-sided insular ischemic stroke, according to an exploratory analysis based on two studies. CONCLUSIONS Patients with insular ischemic stroke exhibit a higher likelihood of rhythm and repolarization abnormalities compared with patients without insular involvement.