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Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis
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 p...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080458/ https://www.ncbi.nlm.nih.gov/pubmed/33948484 http://dx.doi.org/10.1016/j.ijcha.2021.100780 |
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author | Noubiap, Jean Jacques Agbaedeng, Thomas A. Kamtchum-Tatuene, Joseph Fitzgerald, John L. Middeldorp, Melissa E. Kleinig, Timothy Sanders, Prashanthan |
author_facet | Noubiap, Jean Jacques Agbaedeng, Thomas A. Kamtchum-Tatuene, Joseph Fitzgerald, John L. Middeldorp, Melissa E. Kleinig, Timothy Sanders, Prashanthan |
author_sort | Noubiap, Jean Jacques |
collection | PubMed |
description | 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: We included 47 studies reporting on a pooled population of 8,215 patients with CS or ESUS. Using implantable cardiac monitor (ICM), the pooled rate of AF was 12.2% (95% CI 9.4–15.0) at 3 months, 16.0% (95% CI 13.2–18.8) at 6 months, 18.7% (95% CI 15.7–21.7) at 12 months, 22.8% (95% CI 19.1–26.5) at 24 months, and 28.5% (95% CI 17.6–39.3) at 36 months. AF rates were significantly higher in patients with ESUS vs CS (22.0% vs 14.2%; p < 0.001) at 6 months, and in studies using Reveal LINQ vs Reveal XT ICM (19.1% vs 13.0%; p = 0.001) at 12 months. Using mobile cardiac outpatient telemetry (MCOT), the pooled rate of AF was 13.7% (95% CI 10.2–17.2) at 1 month. Predictors of AF detection with ICM included older age, CHA(2)DS(2)-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. |
format | Online Article Text |
id | pubmed-8080458 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-80804582021-05-03 Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis Noubiap, Jean Jacques Agbaedeng, Thomas A. Kamtchum-Tatuene, Joseph Fitzgerald, John L. Middeldorp, Melissa E. Kleinig, Timothy Sanders, Prashanthan Int J Cardiol Heart Vasc Original Paper 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: We included 47 studies reporting on a pooled population of 8,215 patients with CS or ESUS. Using implantable cardiac monitor (ICM), the pooled rate of AF was 12.2% (95% CI 9.4–15.0) at 3 months, 16.0% (95% CI 13.2–18.8) at 6 months, 18.7% (95% CI 15.7–21.7) at 12 months, 22.8% (95% CI 19.1–26.5) at 24 months, and 28.5% (95% CI 17.6–39.3) at 36 months. AF rates were significantly higher in patients with ESUS vs CS (22.0% vs 14.2%; p < 0.001) at 6 months, and in studies using Reveal LINQ vs Reveal XT ICM (19.1% vs 13.0%; p = 0.001) at 12 months. Using mobile cardiac outpatient telemetry (MCOT), the pooled rate of AF was 13.7% (95% CI 10.2–17.2) at 1 month. Predictors of AF detection with ICM included older age, CHA(2)DS(2)-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. Elsevier 2021-04-16 /pmc/articles/PMC8080458/ /pubmed/33948484 http://dx.doi.org/10.1016/j.ijcha.2021.100780 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Paper Noubiap, Jean Jacques Agbaedeng, Thomas A. Kamtchum-Tatuene, Joseph Fitzgerald, John L. Middeldorp, Melissa E. Kleinig, Timothy Sanders, Prashanthan Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis |
title | Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis |
title_full | Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis |
title_fullStr | Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis |
title_full_unstemmed | Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis |
title_short | Rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: A systematic review and meta-analysis |
title_sort | rhythm monitoring strategies for atrial fibrillation detection in patients with cryptogenic stroke: a systematic review and meta-analysis |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080458/ https://www.ncbi.nlm.nih.gov/pubmed/33948484 http://dx.doi.org/10.1016/j.ijcha.2021.100780 |
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